
Class T^, \5 4- 



Book 



JU. 



OFFICIAL DONATION. 



/ 



57th Congress, 

1st Session. 



SENATE. 



Document 
No. 269. 



LETTER 



593 



FROM 



THE SECRETARY OF THE TREASURY, 



TRANSMITTING 



LETTER FROM THE SURGEON-GENERAL OF THE MARINE- 
HOSPITAL SERVICE PRESENTING A REPORT RELATING 
TO THE ORIGIN AND PREVALENCE OF LEPROSY 
IN THE UNITED STATES. 

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March 24, 1902. — Referred to the Committee on Public Health and 
National Quarantine and ordered to be printed. 



WASHINGTON: 

GOVERNMENT PRINTING OFFICE. 

1902. 



fEB 14 1903 
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LETTERS OF TRANSMITTAL. 



Treasury Department, 

Washington, March 21, 1902. 
Sir: I have the honor to transmit herewith a letter from the Sur- 
geon-General of the Marine-Hospital Service, presenting a report of 
a Commission of medical officers appointed under the act of Congress 
approved March 2, 1899, to investigate the origin and prevalence of 
leprosy in the United States and report upon what legislation is neces- 
sary for prevention of the spread of this disease. 
Respectfully, 

L. M. Shaw, Secretary. 
The President of the Senate. 



Treasury Department, 
Office Supervising Surgeon-General M. H. S., 

Washington, March 21, 1902. 
Sir: In accordance with the act of Congress approved March 2, 
1899, I transmit herewith a report of a commission of medical officers 
of the Marine-Hospital Service appointed to investigate the origin and 
prevalence of leprosy in the United States and report upon what 
legislation is necessary for prevention of the spread of this disease. 
Respectfully, 

Walter Wyman, 
Supervising Surgeon- General M. H. S. 

The Secretary of the Treasury. 

3 



LEPROSY IN THE UNITED STATES. 



REPORT OF THE COMMISSION OF MEDICAL OFFICERS OF THE MARINE-HOSPITAL 
SERVICE, APPOINTED BY THE SURGEON-GENERAL OF THE MARINE -HOSPITAL 
SERVICE, WITH THE APPROVAL OF THE SECRETARY OF THE TREASURY, TO 
INVESTIGATE THE ORIGIN AND PREVALENCE OF LEPROSY IN THE UNITED 
STATES, IN COMPLIANCE WITH AN ACT OF CONGRESS APPROVED MARCH 2, 
1899. 



Surg. J. H. White, M. H. S., Chairman; Surg. G. T. Vaughan, M. H. S.; P. A. 

Surg. M. J. Rosenau, M. H. S. 



order of the surgeon-general, m. h. s., appointing commission. 

Treasury Department, 
Office of the Supervising Surgeon-General M. H. S. , 

Washington, December 15, 1899. 

Sirs: You are hereby designated, under the provisions of the act of 
Congress relating to the investigation of leprosy in the United States, 
as a Commission to investigate the origin and prevalence of leprosy in 
the United States and to report upon what legislation is necessary for 
the prevention of the spread of this disease. 

A report by the Sanitary Board, suggesting lines of investigation, 
is inclosed herewith, but the commission will determine its own method 
of procedure in connection with the investigation. 

The commission is also authorized to nominate a clerk, if necessary, 
for the proper conduct of the correspondence. 
Respectfully, 

Walter Wyman, 
Supervising Surgeon- General, M. H. S. 
Surg. J. H. White, P. A. Surg. G. T. Vaughan, and P. A. Surg. 
M. J. Rosenau, 

U. S. Marine- Hospital Service, Washington, D. C. 

Approved. 

L. J. Gage, Secretary. 
5 



6 leprosy in the united states. 

Treasury Department, 

Marine-Hospital Service, 

Washington, November 30, 1901. 
Sir: Pursuant to the instructions contained in your order of Decem- 
ber 15, 1899, designating us as members of a commission to investi- 
gate the origin and prevalence of leprosy in the United States, under 
an act of Congress approved March 2, 1899, as follows: 

Be it enacted by the Senate and House of Representatives of the United States of America 
in Congress assembled, That the Supervising Surgeon-General of the Marine-Hospital 
Service, under the direction of the Secretary of the Treasury, shall appoint a com- 
mission of medical officers of the Marine-Hospital Service to investigate the origin 
and prevalence of leprosy in the United States and report upon what legislation is 
necessary for the prevention of the spread of this disease; the expenses of this inves- 
tigation, not exceeding the sum of five thousand dollars, to be paid from the fund 
for preventing the spread of epidemic diseases, 

we have the honor to submit the accompanying report upon the num- 
ber and location of the lepers found in the United States, together 
with the character of the disease in each case, so far as has been ascer- 
tained, and other data which we have been able to obtain on this 
subject. 

Respectfully, J. H. White, 

Surgeon, M. H. S., Chairman. 
George T. Vaughan, 

Surgeon, M. H. S. 
M. J. Rosenau, 
Passed Assistant Surgeon, M. U.S., Recorder. 
The Surgeon-General Marine-Hospital Service, 

Washington, D. C. 

ACKNOWLEDGMENTS. 

We particularly wish to extend our thanks for much valuable infor- 
mation furnished, to Dr. H. M. Bracken, of St. Paul, Minn. ; Dr. Isa- 
dore Djqy, of New Orleans, La. ; Dr. C. J. Miller, of New Orleans, 
La. ; Dr. D. W. Montgomery, of San Francisco, Cal. ; Dr. A. W. Hitt, 
of New York, N. Y. , and to the officers of the Marine-Hospital Service 
in general, and to Surg. R. D. Murray, stationed at Key West, Fla., 
and to Surg. Gen. Walter Wyman, in particular. 



Treasury Department, 

Marine-Hospital Service, 

Washington, November SO, 1901. 
Sir: Our investigations, in addition to some personal observations 
by the members of the commission, included a very full correspondence 
with each and every State and county health officer in the United 
States, and with prominent leprologists, dermatologists, etc. To many 
of these latter gentlemen we are indebted for most valuable informa- 



LEPEOSY IN THE UNITED STATES. 7 

tion and assistance, and embody in our report the writings of some of 
them, which we deem to be of special value in connection with the 
subject-matter of the report. 

In order to give some idea of the extent of the correspondence 
which has been involved, we would state that, in addition to more than 
10,000 formal letters, over 800 personal letters were addressed by your 
commission to leprologists, dermatologists, secretaries of boards of 
health, and State and county officials. More than 2,700 replies were 
received. Those parties who did not reply to the first letter were, 
after an interval, addressed a second time, and, after a further inter- 
val, a third time when no response had been received to the second 
invitation; so that in the case of counties which are marked "no 
report" in the subjoined list, three successive efforts were made to 
secure information respecting the existence or nonexistence of leprosy 
therein. 

Of the 2,819 counties addressed, replies were received from 2,530, 
and 289 failed to make an} 7 report. 

Your commission does not and can not in the nature of things 
claim to have ascertained the whereabouts of every case of leprosy 
in the United States. Many cases are no doubt so mild as to have 
escaped observation altogether, and many have been purposely hidden. 
Besides this, some persons who claim to have a knowledge of leprosy 
and of lepers in the United States have refused to give any informa- 
tion whatever to } r our Commission. 

It is believed that the information which has been received from 
various sources, and which in some instances has been confirmed by the 
personal observation of the senior member of your Commission, is for 
the most part reliable, and it is a subject for congratulation that the 
number of cases discovered by your Commission within the limits of 
the United States is as small as it has been found to be. There are, 
however, a sufficient number of cases, and there are, in some localities, 
sufficient evidences of endemicit} T and of local spread of the disease, to 
justify the recommendations which we have the honor to submit. 

Taking the reports as they occur, State by State, it would appear to 
your Commission that the number of cases reported from the States of 
New York and California, and from Florida, Louisiana, and some others 
of the Gulf States, is less than the actual number of cases therein. 

Your Commission submits herewith, for convenience in examination 
of the records, tabulated statements, as follows: 

Table No. 1. — A complete list of the cases of leprosy reported, giv- 
ing in each instance, where the information has been furnished, the 
sex, age, nativity, where disease was probably contracted, whether 
patient is isolated or at large, and the variety of the disease. Names 
are omitted. 

Table No. 2. — An alphabetical list of States and Territories of the 
United States (arranged alphabetically by counties), in the case of each 



8 LEPEOSY IN THE UNITED STATES. 

county stating whether or not leprosy exists therein, giving the num- 
ber of cases, where any, or in the case of no report having been 
received so stating. 

Table No. 3. — A condensed summary of all cases of leprosy reported 
to your Commission, arranged alphabetically by States, giving the 
number of cases in each State, number of males and females, number 
of native and foreign born, number who probably contracted the dis- 
ease in the United States, number who probably contracted the disease 
outside the United States, number isolated, number at large, and 
number suffering with the various types of the disease. 

Table No. 4- — A statement of the different nationalities represented 
in the cases of leprosy reported. 

There are, as far as your Commission has been able to ascertain, 278 
cases of leprosy in the United States. The members of your Com- 
mission know full well, however, that this is not a complete census of 
all the cases, and, from the difficulties encountered in collecting these, 
it is our belief that it is impossible to discover all the cases ^of leprosy 
in the United States at any one time. On account of the loathsome 
nature of the disease, which has clung to it from antiquity, there is 
an inclination on the part of the patient himself, as well as upon the 
part of his family and friends, to conceal the affliction from the public. 
This desire is heightened by the character of the pesthouses and prison- 
like leprosaria which at present exist in the United States, such places 
for the most part being unfit for either the treatment or comfort of 
their inmates. 

Of the 278 cases, 145 were born in the United States, 120 in foreign 
countries, and the birthplaces of the remainder, 13, are unknown. 

Of the total number, as reported to your Commission, 186 are given 
as having probably contracted the disease in the United States. While 
your Commission does not wish to discredit the accuracy of the infor- 
mation furnished by the observers who have reported this large propor- 
tion of the cases as having contracted the disease in our country, it feels 
justified in expressing the opinion that some of them, perhaps, brought 
the disease with them from foreign lands. In the case of leprosy it is 
very difficult to determine just where the infection was contracted, 
because the disease sometimes has such a long period of incubation, 
extending in some instances over years. The fact that a person was 
born in the United States, and afterwards contracts leprosy, is not 
sufficiently strong evidence that the disease was contracted in the 
United States, for when such cases are examined more closely the fact 
is often brought to light that they spent a portion of their time in 
China, Hawaiian Islands, West Indies, or other places, where the dis- 
ease prevails in epidemic form. Despite these facts, there is no doubt 
that many of the cases discovered by your Commission, as well as 
others, of which we have no cognizance, have contracted the disease 
in the United States. 



LEPKOSY IN THE UNITED STATES. 9 

Of the total number of cases reported 176 are males and 102 females. 

It is of great importance to note, as a result of the work of your 
Commission, that of the 278 cases of leprosy in the United States only 
72 are isolated. As the disease is a contagious one, even though con- 
tracted with difficulty, the great need of proper institutions in the 
United States where these unfortunate people may be housed and 
treated is apparent not only for the sake of the sick but as a protec- 
tion to the well. 

It will be noted from the tables that the anesthetic variety of the 
disease seems to be more prevalent in the Southern States, while more 
cases of the tubercular variety are reported from the colder latitudes. 
There are decidedly more of the anesthetic variety among the cases 
reported than of the tubercular, which is a practical point in the 
control of the disease, as the anesthetic variety is more difficult of 
diagnosis. 

As far as nationalities are concerned more than half of the total 
number of cases reported to your Commission are American born. 
Scandinavia comes next, there being 22 Norwegian, 11 Icelandic, and 
8 Swede. Of the oriental races, 20 cases are of Chinese and 1 Japan- 
ese. Germany furnished 12 of the cases and the Spanish main 22, 
as follows: Bahamas, 12; Cuba, 6; and other West Indian islands, 4. 
Three of the cases are from Mexico, 6 from Ireland, and 3 from Eng- 
land. The Latin countries are represented by 3 cases from France, 3 
from Italy, and 1 from Spain. In the remaining cases the nationalities 
are scattering or not stated. 

Your Commission limited its labors to the investigation of the disease 
within the boundaries of the United States as they existed at the time 
the law was enacted. The known statistics for the Territory of Hawaii 
are, however, included in the report as being of interest in connection 
with the subject of legislation to prevent not only the spread of the 
disease in the United States proper, but also its introduction from 
transoceanic possessions, as well as from foreign countries. 

Of the States and Territories of the United States 21 are known to 
have lepers, showing the broad distribution of the disease throughout 
the country. 

The report of your Commission shows that the number of cases of 
leprosy in the United States is smaller than is generally and currently 
believed; that leprosy is conveyed from one person to another in the 
United States, such conveyance being most markedly noticeable in the 
States .on the southern coast; that a large majority of the cases of lep- 
rosy in the United States (over 73 per cent) are at large; that at pres- 
ent only 72 of the cases are isolated and provided for b}^ the States or 
cities in which they are located, and that many of those now at large, 
if not all, would be willing to be cared for by the public if proper lep- 
rosaria existed for their treatment and comfort. 



10 LEPROSY IN THE UNITED STATES. 

RECOMMENDATIONS. 

In view of all the facts stated, and of the opinions expressed by 
competent authorities on the subject, some of which we have submitted 
as part of this report, your Commission recommends the establishment 
of at least one — preferably two — national leprosaria for the care and 
treatment of these unfortunate people, to be maintained by and under 
the supervision of the General Government. 

Such leprosaria to be of the greatest benefit must be situated in a 
salubrious climate and be provided with every means for the treat- 
ment and care of their inmates and with the comforts of life and 
sources of occupation and amusement. They must be made as attract- 
ive as it is possible to make them, so as not to be looked upon as a 
species of poorhouse or prison by the victims of the disease. The 
best means to accomplish this end would be the selection of sites cov- 
ering broad areas in healthful localities, where the inmates can have 
unlimited and unrestrained outdoor exercise and occupation, roaming 
over well-kept grounds, enjoying pleasant vistas, or engaged in tilling 
fertile fields as a distraction to their minds and in order to make 
their retreat a comfortable home rather than a miserable place of 
confinement. 

Comfortable houses should be provided. Luxuries are not required,, 
but the institutions should be provided with all the necessities and 
comforts requisite to making these retreats so attractive that, the fact 
becoming widely known, the unfortunate victims of this dread disease 
will, rather than hide their affliction, make known their condition and 
request admission to these public institutions of their own free will. 

The patients must not be made to feel that they are under any 
restraint, and this again emphasizes the fact that large areas must be 
set apart for the uses of these proposed institutions, in most pleasant 
localities as regards climate and temperature. Ideal locations for such 
leprosaria, in the opinion of your Commission, would be (1) the arid 
Southwest; (2) similar regions farther north; (3) an island in the Gulf 
of Mexico, or an island near the Pacific coast of the United States. 

We respectfully submit that the matter of establishing the proposed 

leprosaria and caring for those of our people who are suffering with 

leprosy should be made the subject of earry action by Congress. 

Respectfully, 

J. H. White, 

Surgeon, M. H. S., Chairman. 

George T. Vaughan, 

Surgeon , M. H. S.. 

M. J. RoSENAU, 

Passed Assistant Surgeon, M. H. S. , Recorder. 

The Surgeon-General Marine-Hospital Service, 

Washington, D. C. 



LEPEOSY IN THE UNITED STATES. 

Table No. 1. — Cases of leprosy in the United States. 

ALABAMA. 



11 



No. 


Sex. 


Age. 


xt„+,-~..„m+«t Where probably 
Nationality. contracted. 


Variety. 


Confined or 
at large. 


1 


M. 


50 


1 
American ! United States 


(?) 


At large. 







CALIFORNIA. 



1 


F. 

F. 

F. 
M. 
M. 
M. 
M. 
M. 
M. 
M. 
M. 
M. 
M. 
M. 
F. 
M. 
M. 
F. 
M. 
M. 
M. 
M. 
M. 
M. 


58 
20 
38 
40 
25 
49 
34 
30 
40 
40 
31 
37 
37 
56 
21 
14 
25 
47 
22 
29 


English 


United States 

Hawaii 

Inherited 

United States 

Alaska 

United States 

do 


Tubercular 


Confined 


? 


German 


do 

do 


Do. 


3 


Chinese 


Do. 


4 


Kanaka 


do 


Do. 


5 


Mexican 


do 


Do. 


6 


Swedish 


do 


Do. 


7 


Chinese 


do 

do 


Do. 


8 


do 


Do. 


q 


do 


(?) 

United States 

do 


do 


Do. 


10 


do 


do 


Do. 


11 


do 


do 


Do. 


i? 


do 


do 


do 


Do. 


13 


do... 


China 

United States 

(?) 

Hawaii 

China 

Hawaii 

do 


do 


Do. 


14 


do 


Mixed 

Anaesthetic 


Do. 


15 


do 


At large. 
Do. 


16 


American 


do 


17 


Chinese 


Tubercular 


Do. 


18 


Irish 


Anaesthetic 


Do. 


19 


American 


do 


Do. 


?,n 


do 


do 


do 


Do. 


21 


do 


do 


do 


Do. 


?? 


27 
50 
10 


Chinese 


United States 


Tubercular 


Confined. 


23 


American 


do 


do 


Do. 


?4 


Tahitian 


Tahiti 


do 


Do. 











FLORIDA. 



1 


F. 
M. 
M. 
M. 
M. 
M. 
M. 
F. 
M. 
M. 
M. 
M. 
. M. 
F. 
M. 
F. 
M. 
M. 
M. 
F. 
M. 
F. 
F. 
M. 


60 
12 
25 
28 
40 
12 
16 
35 
16 
20 
40 
50 
60 
40 
35 
30 
45 
50 
50 
55 
18 
40 
23 


Bahamas 


United States 


Anaesthetic 


At large. 
Do. 


?, 


do 


do 


do 


3 


American 


do 


do 


Do. 


4 


do 


...do 


do 


Do. 


5 


Bahamas 


(?) 
United States 


do 


Do. 


6 


Cuban 


do 


Do. 


7 


do 


do 


do 


Do. 


8 


Bahamas 


(?) 
United States 


do 


Do. 


9 


American 


do 


Do. 


10 


do 


do 


do 


Do. 


11 


Bahamas 


..do 


do 


Do. 


1?, 


Cuban 


(?) 

United States 

do 


do 


Do. 


13 


Bahamas 


do 


Do. 


14 


do 


do 


Do. 


15 


do 


do 


do 

do 

do 

do 

do 


Do. 


16 


Cuban 


do 


Do. 


17 


Bahamas 


do 


Do. 


18 


do 


(?) 
United States 


Do. 


19 


do 


Do. 


?n 


do 

Cuban 

do 

American 

(?) 


do 


do 


Do. 


?^ 


do 


do 


Do. 


99 


do 


do 


Do. 


?3 


...do.. 


do 


Do. 


24 


(?) 


n 


Do. 



GEORGIA. 



42 American United States . 



Anaesthetic 



At large. 



ILLINOIS. 



1 

2 


M. 
M. 




3 


M. 




4 


M. 


45 


5 


M. 


23 



Chinese. . . 

Greek 

Mexican . . 
American. 
Australian 



China 

Greece 

Mexico 

United States. 
Hawaii 



(?) 
(?) 

Tubercular. 
do 

Mixed 



At large. 
Do. 
Do. 
Do. 
Do. 



12 



LEPROSY IN THE UNITED STATES. 



Table No. 1. — Cases of leprosy in the United States — Continued. 

IOWA. 



No. 


Sex. 


Age. 


Nationality. 


Where probably 
contracted. 


Variety. 


Confined or 
at large. 


1 


F. 




Norwegian 


Norway 


Tubercular 


At large. 











LOUISIANA. 



1 


F. 
F. 
F. 
F. 
F. 
F. 
M. 
F. 
F. 
M. 
M. 
F. 
M. 
M. 
F. 
F. 
F. 
M. 
F. 
F. 
M. 
M. 
F. 
F. 
M. 
F. 
F. 
F. 
M. 
M. 
F. 
M. 
M. 
M. 
F. 
F. 
F. 
F. 
F. 
F. 
M. 
F. 
M. 
M. 
M. 
F. 
F. 
F. 
M. 
F. 
F. 
M. 
F. 
M. 
F. 
M. 
M. 
M. 
M. 
F. 
F. 
M. 
M. 
F. 
F. 
M. 
M. 
M. 
M. 
F. 
F. 
M. 
F. 
F. 


25 
40 
34 
50 
30 
29 
40 
19 
10 
32 
40 
35 
21 
24 
50 
48 
37 
44 
25 
50 
44 
19 
54 
47 
16 
46 
34 
71 
12 
25 
25 
43 
16 
58 
10 
46 
16 

19 

44 
33 
50 
58 
30 
12 
61 
40 
19 
62 
11 
17 
19 
30 
47 
36 
28 
10 
37 

17 
52 

55 
37 
60 
64 
45 
50 
27 
40 
40 
54 
42 


American 


United States 


Mixed 


At large. 
Do. 


9 


do 


do 


Tubercular 


s 


...do 


do 


Anaesthetic 


Do. 


A 


do 


do 


Mixed 


Do. 


5 


do 


do 


do .. 


Do. 


6 


do 


do 


: do .. 


Do. 


7 


German 


do 


Tubercular 


Do. 


8 


American 


do 


do 


Do. 


q 


do 


do 


Anaesthetic 


Do. 


10 


do 


do 


Tubercular 


Do. 


11 


...do 


do 


Mixed 


Do. 


T> 


...do 


do 


Mutilating . . 


Do. 


is 


...do 


do 


Tubercular .. 


Confined. 


l-i 


...do 


do 


Anaesthetic 


Do. 


15 


do 


do 


Tubercular 


Do. 


16 


do 


do 


Mixed 


At large. 
Do. 


17 


do 


do 


Anaesthetic 


18 


do 


do 


do 


Do. 


19 


...do 


do 


...do 


Do. 


?n 


Swede 


do 


Mixed 


Do. 


?1 


American 


do 


Anaesthetic 


Do. 


99 


do 


do 


do 


Do. 


*>s 


German 


do 


Mixed 


Do. 


94 




do 


Tubercular 


Do. 


?Fi 


do 


do 


Mixed 


Do. 


?6 


...do 


do 


Anaesthetic 


Do. 


97 


...do 


do 


do 


Do. 


*>8 


German 


do 


Mixed 


Do. 


9q 


American 


do 


Anaesthetic 


Do. 


SO 


...do 


do 


do 


Do. 


SI 


English 


....do 


Mixed 


Do. 


32 


American 


do 


Tubercular 


Do. 


33 


...do 


...do 


Mixed 


Do. 


34 


Spanish 


...do 


Anaesthetic 


Do. 


35 


American 


do 


Tubercular 


Confined. 


36 


..do 


do 


Anaesthetic 


At large. 
Confined. 


37 


..do 


...do 


do 


38 
39 


(?) 
American 


(?) 
United States 


(?) 
Anaesthetic 


At large. 
Do. 


40 


...do 


do 


Tubercular 


Do. 


41 


...do... 


do 


Mixed 


Confined. 


42 


..do 


do 


Anaesthetic 


At large. 


43 


Irish 


do 


Trophic 


Do. 


44 


American 


...do 


Anaesthetic 


Do. 


45 


.do 


..do 


Tubercular 


Do. 


■16 


German 


do 


Mixed 


Do. 


-17 


American 


do 


Tubercular 


Do. 


48 


.do 


do 


Anaesthetic 


Do. 


-19 


Irish .. 


do 


do 


Do. 


•SO 


American 


....do 


Tubercular 


Confined. 


^1 


..do.. 


do 


Anaesthetic 


At large. 


59 


..do. 


do 


Mixed 


Do. 


(S3 


..do.., 


...do 


Anaesthetic 


Do. 


54 


...do 


do 


do 


Do. 


55 


do 


do 


Mixed 


Do. 


56 


do ; 


do 


Trophic 


Do. 


57 


..do.. 


...do 


Anaesthetic 


Do. 


58 


...do... 


...do 


Mixed 


Do. 


59 


. ( ? ) 
American . 


(?) 
United States 


Trophic 


Do. 


60 


Anaesthetic 


Do. 


61 


German . 


...do 


do 


Do. 


62 
63 
64 


(?) 

(?) 

French 


(?) 

(?) 

United States 


(?) 

(?) 

Anaesthetic 


Do. 
Do. 
Do. 


65 


American 


..do 


do 


Do. 


66 


(?) 
Amp.np.an . . 


do 


do 


Do. 


67 


.do 


Tubercular 


Do. 


68 


do 


..do 


do 


Do. 


69 


do 


...do 


do 


Confined. 


70 


do 


do 


Mixed 


At large. 


71 


...do.. 


...do 


Trophic 


Confined 


79 


do 


do 


Mixed 


At large. 


7S 


do 


do 


Trophic 


Do. 


74 


do 


do 


Tubercular 


Do. 



LEPKOSY IN THE UNITED STATES. 



13 



Table Xo. 1. — Cases of leprosy in the United States — Continued. 
LOUISIANA— Continued. 




Variety, 



Confined or 
at large. 



Trophic 

Tubercular . 

Mixed 

Tubercular . 

....do 

Mixed 

....do 

Anaesthetic . 

....do 

Trophic 

Tubercular . 

Mixed 

Anaesthetic . 
Tubercular . 
Anaesthetic . 
Tubercular . 

Trophic 

Tubercular . 

Mixed 

Anaesthetic . 

....do 

Mixed 

Anaesthetic . 

(?) 

Mixed 

Trophic 

Anaesthetic . 

....do 

Mixed 

Tubercular . 
Anaesthetic . 
Tubercular . 
Mixed 

Anaesthetic . 
Mixed 

do 

do 

do 

do 

Anaesthetic . 

do 

Mixed 

do 

Anaesthetic . 

Mixed 

Tubercular . 
Anaesthetic . 

do 

Mixed 

Anaesthetic . 
Mixed 

do 

do 

do 

Anaesthetic . 
Tubercular . 
Anaesthetic . 

....do 

Tubercular . 
Anaesthetic . 

Mixed 

....do 

Anaesthetic . 

....do 

Mixed 

....do 

Tubercular . 
Anaesthetic . 

Mixed 

Anaesthetic . 

Mixed 

Anaesthetic . 

....do 

(?) 

(?) 

Tubercular . 

Mixed 

(?) 
Tubercular . 
....do 



At large. 

Do. 

Do. 

Do. 

Do. 

Do. 
Confined. 
At large. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
Confined. 

Do. 
At large. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
Confined. 

Do. 

Do. 
At large. 

Do. 

Do. 

Do. 
Confined. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
At large. 

Do. 

Do. 
Confined. 
At large. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
Confined. 

Do. 
At large. 

Do. 



14 



LEPEOSY IN THE UNITED STATES. 



Table No. 1. — Cases of leprosy in the United States — Continued. 

MARYLAND. 



No. 


Sex. 


Age. 


Nationality. 


Where probably 
contracted. 


Variety. 


Confined or 
at large. 


1 


F. 


37 


American 


United States 


Mixed 


At large. 











MASSACHUSETTS. 



M. 
M. 



23 
40 



Japanese . 
American 



Hawaii 



(?) 



Tabercular 
do 



At large. 
Confined. 



MINNESOTA. 



1 


M. 
M. 
F. 
M. 
M. 
M. 
F. 
M. 
M. 
M. 
M. 
M. 
M. 
M. 
M. 
M. 
M. 
M. 
M. 
M. 


44 
80 
60 
33 
48 
40 
35 
53 
39 
42 
67 
44 
32 
55 


Swede 


Sweden 


Anaesthetic 


Confined. 


?, 


Norwegian 


Norway 


do 


Isolated. 


8 


do 


do 


do 


At large. 
Isolated. 


4 


do 


do 


Tubercular 


ft 


do 


do 


do 


Do. 


6 


do 


do 


Anaesthetic 


At large. 
Isolated. 


7 


Swede 


Sweden 


Tubercular 


8 


Norwegian 


Norway 


Anaesthetic 


At large. 
Do. 


q 


Swede 


Sweden 


Tubercular 


10 


do 


do . 


do 


Do. 


n 


Norwegian 


Norway 


do 


Isolated. 


1? 


do 


do .... 


...do .. 


At large. 
Do. 


13 


do 


do 


Mixed 


14 


do 


do 


Anaesthetic 


Do. 


1ft 


do 


do 


Tubercular 


Do. 


16 


31 
55 


do 


do 


do 


Do. 


17 


do 


do 


Anaesthetic 


Do. 


18 


do 


do 


Tubercular 


Do. 


IP 




do 


do 


Anaesthetic 


Do. 


?0 




do 


do 


(?) 


Do. 













MISSISSIPPI. 



1 


F. 


80 


2 


M. 


55 


3 


M. 


40 


4 


M. 


30 


5 


F. 


67 



American . 

....do 

....do 

....do 

....do 



United States. 

do 

do 

do 

do 



Tubercular. 

do 

Anaesthetic 

do 

Tubercular 



At large. 

Do. 
Isolated. 

Do. 
At large. 



MISSOURI. 



1 


F. 


35 


2 


M. 


56 


3 


F. 


32 


4 


M. 


50 


5 


M. 


34 



American . 

Irish 

American . 

do 

Chinese . . . 



Mexico 

(?) 
United States. 

do 

China 



Tubercular 
Anaesthetic 
Tubercular 

do 

Anaesthetic 



At large. 

Do. 

Do. 

Do. 
Confined. 



MONTANA. 


1 


M. 




Chinese 


China 


Anaesthetic 


At large. 








NEVADA. 


1 


M. 


53 


Chinese 


United States 


Anaesthetic 


At large. 








NEW YORK. 



1 


M. 


28 


2 


M. 


20 


3 


M. 


14 


4 


M. 


28 


5 


M. 


7 


6 


M. 




7 


M. 


30 



West Indian 

do 

do 

Chinese 

West Indian 

Sicilian 

American . . . 



West India ... 

do 

do 

United States. 
West India . . . 

(?) 
United States. 



Anaesthetic 

do 

Mixed 

Tubercular 
Anaesthetic 

do 

do , 



At large. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 



LEPKOSY IN THE UNITED STATES. 



15 



Table No. 1. — Cases of leprosy in the United States — Continued. 

NORTH DAKOTA. 



No. ! Sex. 



1 
2 
3 

4 
5 

6 
7 
8 
9 

10 
11 
12 
13 
11 
15 
16 



M. 
M. 
M. 
M. 
F.« 
F. 
M. 
M. 
F. 
M. 
F. 
F. 
M. 
F. 
M. 
M. 



Age. 



53 
30 



L'2 
35 

IS 
17 

56 
40 
58 



Nationality. 



Norwegian . 

Swede 

Chinese 

Icelander . . 

do 

do 

do 

do 

.....do 

do 

do 

do 

do 

do 

Chinese 

Norwegian. 



1 


M. 


57 


2 


F. 


36 


3 


M. 


50 



English . . . 
German. ., 
American. 



Where probably 
contracted. 



Norway 
Sweden. 
China .. 
Iceland. 

do.. 

do.. 

do.. 

do.. 

do.. 

do.. 

do.. 

do.. 

do.. 

do.. 

China .. 
Norway. 



Variety. 



Tubercular . 
do 

(?) 

Tubercular . 

do 

Anaesthetic . 

Tubercular . 

do 

do 

Anaesthetic . 

Tubercular . 

do 

do 

(?) 
(?) 

Tubercular . 



China 

Mexico 

United States. 



Tubercular 

Mixed 

do 



Confined or 
at large. 



Isolated. 

Do. 
At large. 
Confined. 
At large. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
Isolated. 



OREGON. 


1 


M. 


35 


Chinese 


China 


. Tubercular 


(?) 






PENNSYLVANIA. 


1 


F. 


78 


American 


United States 


. Mixed 


Confined. 










SOUTH DAKOTA. 


1 


M. 


19 


Norwegian 


Norway 


. I Tubercular 


Confined. 










TEXAS. 



At large. 
Isolated. 
At large. 



WISCONSIN. 



1 


M. 
F. 
F. 


66 
42 


Norwegian 


Norway 

Sweden 

Norway 


Anaesthetic 


At large. 


? 


Swede 


Tubercular 


Do. 


3 


Norwegian 


do 


Do. 













Table No. 2.- 



-List of States, arranged alphabetically, showing the presence or absence of 
leprosy in each county. 



ALABAMA. 



County. 


Cases of leprosy 
reported. 


r t Cases of leprosy 
CountJ • reported. 


Autauga 


None. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 

Do. 
• None. 


Cleburne 


None. 


Baldwin 


Coffee 


Do. 


Barbour 


Colbert 


Do. 


Bibb 


Conecuh 


Do. 


Blount 


Coosa 


Do. 


Bullock 


Coyington 

Crenshaw 


Do. 


Butler 


Do. 


Calhoun 


Cullman 


1 case. 


Chambers 


Dale 


None. 


Cherokee 


Dallas 


Do. 


Chilton 


Dekalb 


Do. 


Choctaw 


Elmore 


Do. 


Clarke 


Escambia 


No report. 
None. 


Clay 


Etowah 



16 



LEPEOSY IN THE UNITED STATES. 



Table No. 2. — List of States, arranged alphabetically, showing the presence or absence of 

leprosy in each county — Continued. 



ALABAMA— Continued. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Fayette 


None. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 
No report. 
None. 
No report. 
None. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 


Mobile 


None. 


Franklin 


Monroe 


Do. 


Geneva 


Montgomery 


Do. 


Greene 


Morgan 


Do. . 


Hale 


Perry 


No report. 
None. 


Henry 


Pickens 


Jackson 


Pike 


1 suspected case. 
None. 


Jefferson 


Randolph 


Lamar 


Russell 


Do. 


Lauderdale 


St. Clair 


Do. 


Lawrence 


Shelbv 


Do. 


Lee 


Sumter 


Do. 


Limestone 


Talladega 


Do. 


Lowndes 


Tallapoosa 


Do. 


Macon 


Tuscaloosa 


Do. 


Madison 


Walker 


Do. 


Marengo 


Washington 


No report. 
None. 


Marion 


Wilcox 


Marshall 


Winston 


Do. 









Alabama. — Sixty-six counties. Fifty-four counties report no cases of leprosy therein. Cullman 
County reports 1 case of leprosy and Pike County 1 case of suspected leprosy. No report was received 
from the following 10 counties: Bibb, Choctaw, Clarke, Escambia, Henry, Lauderdale, Lee, Marengo, 
Perry, and Washington. 

ARIZONA. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Apache 


None. 

Do. 
No report. 

Do. 

Do. 
None 

Do. 


Na vaj o 


None. 


Cochise 


Pima 


Do. 


Coconino 


Pinal 


Do. 


Gila 


Santa Cruz 


No report. 
Do. 


Graham 


Yavapai 


Maricopa 


Yuma 


None. 


Mohave 











Arizona. — Thirteen counties. Eight counties report no cases of leprosy therein. Dr. George 
Goodfellow, Tucson, Ariz., says: "No cases ever reported in Arizona." No report was received from 
the following five counties: Coconino, Gila, Graham, Santa Cruz, and Yavapai. 

ARKANSAS. 




Arkansas . 

Ashley 

Baxter 

Benton . . . 

Boone 

Bradley . . . 
Calhoun . . 

Carroll 

Chicot 

Clark 

Clay 

Cleburne . 
Cleveland. 
Columbia . 
Conway . . . 
Craighead. 
Crawford . 
Crittenden 

Cross 

Dallas 

Desha 

Drew 

Faulkner . 
Franklin.. 

Fulton 

Garland... 
Grant 



No report. 

Do. 
None. 

Do. 
No report. 
None. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 



Greene 

Hempstead . . . 
Hot Springs . . 

Howard 

Independence 

Izard 

Jackson 

Jefferson 

Johnson 

Lafayette 

Lawrence 

Lee 

Lincoln 

Little River . . 

Logan 

Lonoke 

Madison 

Marion 

Miller 

Mississippi ... 

Monroe 

Montgomery . 

Nevada 

Newton 

Ouachita 

Perry 

Phillips 



None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 



LEPEOSY EST THE UNITED STATES. 



17 



Table No. 2. 



-List of States, arranged alphabetically, showing the presence or absence of 
leprosy in each county — Continued. 



ARKANSAS— Continued. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Pike . 


None. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 


Sebastian 


No report. 


Poinsett 


Sevier 


Do. 


Polk . . 


Sharp 


None. 


Pope 


Stone 


Do. 


Prairie 


Union 


Do. 


Pulaski 


Van Buren 


Do. 


Randolph 


Washington 


Do. 


St. Francis 


White 


Do. 


Saline 


Woodruff 


Do. 


Scott 


Yell 


Do. 


Searcy 











Akkansas. — Seventy-five counties. Sixty-five counties report no cases of leprosy therein. No 
report was received from the following ten counties: Arkansas, Ashley, Boone, Chicot, Franklin, 
Lawrence, Lonoke, Pulaski, Sebastian, and Sevier. 



Countv. 



Cases of leprosy 
reported. 



Alameda 

Alpine 

Amador 

Butte 

Calaveras . . . 

Colusa 

Contra Costa 
Del Norte . . . 
Eldorado . . . 

Fresno 

Glenn 

Humboldt . . 

Kern 

Kings 

Lake 

Lassen 

Los Angeles. 

Madera 

Marin . .. 

Mariposa ... 
Mendocino . 

Merced 

Modoc 

Mono 

Monterey ... 

Napa 

Nevada 

Orange 



1 case. 
None. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 
No report. 
None. 

Do. 

Do. 
No report. 
None. 

Do. 
1 case. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 



County. 



Placer 

Plumas 

Riverside 

Sacramento 

San Benito 

San Bernardino 

San Diego 

San Francisco . . 

San Joaquin 

San Luis Obispo 

San Mateo 

Santa Barbara.. 

Santa Clara 

Santa Cruz 

Shasta 

Sierra 

Siskiyou 

Solano 

Sonoma 

Stanislaus 

Sutter 

Tehama 

Trinity 

Tulare 

Tuolumne 

VentUra 

Yolo 

Yuba 



Cases of leprosy 
reported. 



None. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 
18 cases. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 

Do. 
None. 

Do. 

Do. 

Do. 



Califoknia. — Fifty-six counties. Forty-six counties report no cases of leprosy therein. One case 
of leprosy is reported in Alameda County, one case in Los Angeles County, and 18 cases in San Fran- 
cisco County. Four cases are reported at large in the State whose definite location is not given. The 
following seven counties have not reported: Contra Costa, Fresno, Kings, Madera, San Bernardino, 
Trinity, and Tulare. 

COLORADO. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Arapahoe 


None. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 


Dolores 


None. 


Archuleta 


Douglas 


Do. 


Baca 


Eagle 


Do. 


Bent 


Elbe t 


Do. 


Boulder 


El Paso 


Do. 


Chaffee 


Fremont 


Do. 


Chevenne 


Garfield 


No report. 
Do. 


Clear Creek 


Gilpin 


Conejos 


Grand 


None. 


Costilla 


Gunnison 


Do. 


Custer 


Hinsdale 


Do. 


Delta 




Do. 



S. Doc. 269- 



18 



LEPEOSY IN THE UNITED STATES. 



Table No. 2. — List of States, arranged alphabetically, showing the presence or absence of 

leprosy in each county — Continued. 

COLORADO— Continued, 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Jefferson 


None. 
Do. 
Do. 
Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 


Phillips 


None. 


Kiowa 


Pitkin 


Do. 


Kit Carson 


Prowers 


Do. 


Lake 


Pueblo 


Do. 


La Plata 


Rio Blanco 


Do. 


Larimer 


Rio Grande 


Do. 


Las Animas 


Routt 


Do. 


Lincoln 


Saguache 


Do. 


Logan 


San Juan 


Do. 


Mesa 


San Miguel 


Do. 


Mineral 


Sedgwick 


Do. 


Montezuma 


Summit 


Do. 


Montrose 


Teller 


Do. 


Morgan 


Washington 


Do. 


Otero 


Weld 


Do. 


Ouray 


Yuma 


Do. 


Park 











Colorado. — Fifty-seven counties. Fifty-three report no cases of leprosy therein. Dr. G. E. Tyler, 
secretary, Colorado State board of health, says: "So far as I am aware, there are no cases of leprosy 
within the State of Colorado." No report was received from the following four counties: Archuleta, 
Garfield, Gilpin, and Morgan. 

CONNECTICUT. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Fairfield 


None. 

Do. 

Do. 
No report. 


New Haven 


None. 


Hartford 


New London 

Tolland 


Do. 


Litchfield 


Do. 


Middlesex 


Windham 


Do. 









Connecticut. — Eight counties. Seven counties report no cases of leprosy therein. No report was 
received from Middlesex County. 

DELAWARE. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Kent 


None. 
Do. 


Sussex 


None. 


Newcastle 











Delaware. — Three counties report no cases of leprosy therein. 

DISTRICT OF COLUMBIA. 



County. 



Cases of leprosy 
reported. 



Washington 



None. 



District of Columbia.— Reports indicate that no cases of leprosy exist in the District of Columbia. 

FLORIDA. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Alachua 


1 suspected case. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 


Dade 


None. 


Baker 


De Soto 


Do. 


Bradford 


Duval 


Do. 


Brevard 


Escambia 


1 case. 


Calhoun 


Franklin 


None. 


Citrus 


Gadsden 


Do. 


Clay 


Hamilton 


Do. 






Do. 



LEPEOSY IN THE UNITED STATES. 



19 



Table No. 2. — List of States, arranged alphabetically, showing the presence or absence of 

leprosy in each county — Continued. 

FLORIDA— Continued. 



Countv. 



Hillsboro 

Holmes . . 
Jackson.. 
Jefferson . 
Lafayette 

Lake 

Lee 

Leon 

Levy 

Liberty .. 
Madison . 
Manatee . 
Marion... 
Monroe .. 



Cases of leprosy 
reported. 



lease; 1 suspected 

case. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

DO. 

Do. 
1 suspected case. 
22 cases. 



Countv. 



Nassau 

Orange 

Osceola 

Pasco 

Polk 

Putnam 

St. John 
Santa Rosa. 

Sumter 

Suwanee ... 

Taylor 

Volusia 

Wakulla.... 

Walton 

Washington 



Cases of leprosy 
reported. 



None. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 
Do. 
Do. 
No report. 
None. 

Do. 

Do. 

Do. 



Florida.— Forty-five counties. Thirty-six counties report no cases of leprosy therein. Cases of 
suspected leprosy* are reported in Alachua, Hillsboro, and Marion counties. One case of leprosy in 
Hillsboro County, 1 case in Escambia County, and 22 cases in Monroe County. No report from the 
following counties: Columbia, Holmes, St. John, and Taylor. 

GEORGIA. 



Countv. 



Appling 

Baker 

Baldwin 

Banks 

Bartow 

Berrien 

Bibb 

Brooks 

Brvan 

Bulloch 

Burke 

Butts 

Calhoun 

Camden 

Campbell 

Carroll 

Catoosa 

Charlton 

Chatham 

Chattahoochee 

Chattooga 

Cherokee 

Clarke 

Clay 

Clavton 

Clinch 

Cobb 

Coffee 

Colquitt 

Columbia 

Coweta 

Crawford 

Dade 

Dawson 

Decatur 

Dekalb 

Dodge 

Dooly 

Dougherty 

Douglas 

Early 

Echols 

Effingham .... 

Elbert 

Emanuel 

Fannin 

Fayette 

Floyd 

Forsyth 



Cases of leprosy 
reported. 



None. 
No report. 
None. 

Do. 

Do. 
No report. 
None. 

Do. 
No report. 

Do. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 
No report. 

Do. 
None. 
No report. 
None. 

Do. 

Do. 
No report. 
None. 

Do. 
No report. 

Do. 




Franklin 

Fulton 

Gilmer 

Glascock . . . 

Glynn , 

Gordon 

Greene 

Gwinnett 

Habersham.. 

Hall 

Hancock 

Haralson 

Harris , 

Hart 

Heard 

Henry 

Houston 

Irwin 

Jackson ...V 

Jasper 

Jefferson 

Johnson 

Jones 

Laurens 

Lee 

Liberty 

Lincoln 

Lowndes 

Lumpkin 

McDuffie 

Mcintosh 

Macon 

Madison 

Marion , 

Meriwether 

Miller 

Milton 

Mitchell 

Monroe 

Montgomery 

Morgan 

Murray 

Muscogee.. . 

Newton 

Oconee 

Oglethorpe . 

Paulding 

Pickens 

Pierce 



Cases of leprosy 
reported. 



None. 
One case. 
None. 

Do. 

Do. 
No report. 
None. 
No report. 
None. 
No report. 
None. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 
No report. 

Do. 
None. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 
No report. 

Do. 

Do. 
None. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 



20 



LEPKOSY IN THE UNITED STATES. 



Table No. 2. — List of States, arranged alphabetically, shoiving the presence or absence of 

leprosy in each county — Continued. 

GEORGIA— Continued . 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Pike 


None. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 
No report. 
None. 

Do. 


Thomas 


None. 


Polk 


Towns 


Do. 


Pulaski 


Troup : 


No report. 
Do. 


Putnam 


Twiggs 


Quitman 


Union 


None. 


Rabun 


Upson 


Do. 


Randolph 


Walker 


Do. 


Richmond 


Walton 


Do. 


Rockdale 


Ware 


Do. 


Schley 


Warren 


No report. 
None. 


Screven *. 


Washington 


Spalding 


Wavne 


Do. 


Stewart 


Webster 


Do. 


Sumpter 


White 


No report. 
Do. 


Talbot 


Whitfield 


Taliaferro 


Wilcox 


Do. 


Tattnall 


Wilkes 


Do. 


Taylor 


Wilkinson 


None. 


Telfair 


Worth 


Do. 


Terrell 











Georgia. — One hundred and thirty-seven counties. Ninety-nine counties report no cases of lep- 
rosy therein. One case of leprosy is reported to be in Fulton County. Two cases of suspected leprosy 
were reported from Spalding County, which upon investigation proved to be not leprosy. No 
report was received from the following thirty-seven counties: Baker, Berrien, Bryan, Bulloch, Chat- 
tahoochee, Colquitt, Dade, Dooly, Dougherty, Early, Emanuel, Floyd, Forsyth, Gordon, Gwinnett, 
Hall, Heard, Jackson, Jones, Laurens, Lowndes, Madison, Miller, Milton, Mitchell, Murray, Pauld- 
ing, Rabun, Sumter, Taylor, Troup, Twiggs, Warren, White, Whitfield, Wilcox, and Wilkes.* 

IDAHO. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Ada 


None. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 


Idaho 


None. 


Bannock 


Kootenai 


Do. 


Bear Lake 


Latah 


Do. 


Bingham 


Lemhi 


Do. 


Blaine 


Lincoln 


Do. 


Boise 


Nez Perces 


No report. 


Canyon 


Oneida 


None. 


Cassia 


Owvhee 


Do. 


Custer 


Shoshone 


No report. 


Elmore 

Fremont 


Washington 


None. 







Idaho. — Twenty-one counties. Eighteen counties report no cases of leprosy therein, 
was received from the following three counties: Bear Lake, Nez Perces, and Shoshone. 



No report 



ILLINOIS. 




Adams 

Alexander . . 

Bond 

Boone 

Brown 

Bureau 

Calhoun 

Carroll 

Cassf 

Champaign . 

Christian 

Clark 

Clay 

Clinton 

Coles 

Cook 

Crawford ... 
Cumberland 



None 

Do. 

Do. 

Do. 

Do. 

Do. 
No report 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
5 cases. 
None. 

Do. 



Dekalb 

Dewitt 

Douglas ... 

Dupage 

Edgar 

Edwards . . 
Effingham. 

Fayette 

Ford 

Franklin .. 
Fulton .... 
Gallatin . . . 

Greene 

Grundy 

Hamilton . 
Hancock .. 

Hardin 

Henderson 



None. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 



LEPEOSY IN THE UNITED STATES. 



21 



Table No. 2. — List of States, arranged alphabetically, shoiving the presence or absence of 

leprosy in each county — Continued. 



ILLINOIS— Continued . 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Henrv 


None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 

Do. 
None. 

Do. 

Do. 


Moultrie 


None. 


Iroquois 


Ogle 


Do. 


Jackson .. 


Peoria 


No report. 


Jasper 


Perry 


None. 


Jefferson . 


Piatt 


Do. 


Jersey 


Pike 


Do. 


Jo Daviess 


Pope 


Do. • 


Johnson 


Pulaski 


Do. 


Kane 


Putnam 


Do. 


Kankakee 


Randolph 


Do. 


Kendall 


Richland 


Do. 


Knox 


Rock Island 


Do. 


Lake 


St. Clair 


Do. 


Lasalle 


Saline 


Do. 


Lawrence 


Sangamon 


Do. 


Lee 


Schuyler 


Do. 


Livingston 


Scott 


No report. 


Logan 


Shelby 


None. 


McDonough 


Stark 


Do. 


McHenry 


Stephenson 


Do. 


McLean 


Tazewell 


Do. 


Macon 


Union 


No report. 


Macoupin 


Vermilion 


Do. 


Madison 


Wabash 


Do. 


Marion 


Warren 


Do. 


Marshall 


Washington 


Do. 


Mason 


Wayne 


Do. 


Massac 


White 


Do. 


Menard 


Whiteside 


Do. 


Mercer 


Will 


Do. 


Monroe 


Williamson 


Do. 


Montgomery 


Winnebago 


Do. 


Morgan 


Woodford 


Do. 









Illinois.— One hundred and two counties. Ninety-one counties report no cases of leprosy therein. 
Five cases of leprosy are reported to be in Cook County. No report was received from the following 
ten counties: Calhoun, Edgar, Franklin, Hardin, Johnson, Menard, Mercer, Peoria, Scott, and Union. 

INDIANA. 



County. 


Cases of leprosy 
reported. 


County. 


Cases or leprosy 
reported. 


Adams 


None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
• Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 


Henrv 


None. 


Allen 


Howard 


Do. 


Bartholomew 


Huntington 


Do. 


Benton 


Jackson 


Do. 


Blackford 


Jasper 


Do. 


Boone 


Jav 


Do. 


Brown 


Jefferson 


Do. 


Carroll 


Jennings 


Do. 


Cass 


Johnson 


Do. 


Clark 


Knox 


Do. 


Clay 


Kosciusko 


Do. 


Clinton 


Lagrange 


Do. 


Crawford 


Lake 


No report. 


Daviess 


Lanorte 


None. 


Dearborn 


Lawrence 


Do. 


Decatur 


Madison 


Do. 


Dekalb 


Marion 


Do. 


Delaware 


Marshall 


Do. 


Dubois 


Martin 


Do. 


Elkhart 


Miami 


Do. 


Fayette 


Monroe 


Do. 


Floyd 


Montgomery 


Do. 


Fountain 


Morgan 


Do. 


Franklin 


Newton 


Do. 


Fulton 


Noble 


Do. 


Gibson 


Ohio 


Do. 


Grant 


Orange ■ 


Do. 


Greene 


Owen 


Do. 


Hamilton 


Parke 


Do. 


Hancock 


Perry 


Do. 


Harrison 


Pike 


Do. 


Hendricks 


Porter 


Do. 



22 



LEPKOSY IN THE UNITED STATES. 



Table No. 2. — List of States, arranged alphabetically, showing the presence or absence of 

leprosy in each county — Continued. 

INDIANA— Continued. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Posey 


None. 
Do. 
Do, 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 


Tippecanoe 


None. 


Pulaski 


Tipton 


Do. 


Putnam 


Union 


Do. 


Randolph 


Vanderburg 


Do. 


Ripley 


Vermilion 


Do 


Rush 


Vigo 


Do 


St. Joseph 


Wabash 


Do. 


Scott. .". 


Warren 


Do. 


Shelby 


Warrick 


Do. 


Spencer 


Washington 


Do 


Starke 


Wayne 


Do 


Steuben 


Wells 


Do. 


Sullivan 


White 


Do. 


Switzerland 


Whitley 


Do. 









Indiana.— Ninety-two counties. Ninety counties report no'cases of leprosy therein. Dr. J. N. Hurty, 
secretary State board of health, Indianapolis, says: "Not a case of leprosy in Indiana so far as I 
know." No report was received from the following counties: Hancock and Lake. 

INDIAN TERRITORY. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Cherokee Nation 


No report. 
None. 
No report. 
None. 
Do. 


Peoria Nation 


No report. 

None. 


Chickasaw Nation 


Quapaw Nation 


Choctaw Nation 


Seminole Nation 


No report. 
Do. 


Creek Nation 


Seneca Nation 


Ottawa Nation 


Wyandotte Nation 


None. 









Indian Territory. — Ten counties. Five counties report no cases of leprosy therein, while no 
report was received from any of the remaining five counties. 

IOWA. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Adair 


None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
1 suspected case. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 


Fremont 


None. 


Adams 


Greene 


Do. 


Allamakee 


Grundy 


Do. 


Appanoose 


Guthrie 


Do. 


Audubon 


Hamilton 


Do. 


Benton 


Hancock 


Do. 


Blackhawk 


Hardin 


No report. 
None. 


Boone 


Harrison 


Bremer 


Henry 


Do. 


Buchanan 


Howard 


Do. 


Buena Vista 


Humboldt 


Do. 


Butler 


Ida 


Do. 


Calhoun 


Iowa 


No report. 
None. 


Carroll 


Jackson 


Cass 


1 Jasper 


Do. 


Cedar 


Jefferson : 


Do. 


Cerro Gordo 


Johnson 


Do. 


Cherokee 


Jones 


No report. 


Chickasaw 


Keokuk 


None. 


Clarke 




Do. 


Clay 


Lee 


Do. 


Clayton 




Do. 


Clinton 




Do. 


Crawford 


Lucas 


Do. 


Dallas 


Lyon 


Do. 


Davis 


Madison 


Do. 


Decatur 


Mahaska 


Do. 


Delaware 


Marion 


Do. 


Des Moines . 


Marshall 


Do. 


Dickinson 


Mills 


Do. 


Dubuque 


Mitchell 


Do. 


TflTnmfit, 




Do. 


Fayette 




Do. 


Floyd 




Do. 


Franklin 


Muscatine 


Do. 



LEPEOSY IN THE UNITED STATES. 



23 



Table No. 2. — List of States, arranged alphabetically, showing the presence or absence of 

leprosy in each county — Continued. 



IOWA— Continued. 



County. 
t 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


O'Brien 


None. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 


Tama 


None. 


Osceola 


Taylor 


Do. 


Page 


Union 


Do. 


Palo Alto 


Van Buren 


No report. 
Do. 


Plymouth .. 


Wapello 


Pocahontas . 


Warren 


None. 


Polk 


Washington 

Wayne 


Do. 


Pottawattamie 


Do. 


Poweshiek 


Webster 


Do. 


Ringgold 


Winnebago 


Do. 


Sac 


Winneshiek 


Do. 


Scott 


Woodburv 


Do. 


Shelby 


Worth 


Do. 


Sioux 


Wright 


Do. 


Story 











Iowa. — Ninety-nine counties. Ninety-two counties report no cases of leprosy therein. Boone 
County reports one case of suspected leprosy. One case of leprosy is reported in Iowa, but it is 
not definitely located. Two cases of leprosy in Iowa have died within the past two years. No report 
was received from the following six counties: Clay, Decatur, Hardin, Iowa, Jones, and Van Buren. 

KANSAS. 



Countv. 



Allen 

Anderson . . . 
Atchison.... 

Barber 

Barton 

Bourbon 

Brown 

Butler 

Chase 

Chautauqua 
Cherokee ... 
Cheyenne... 

Clark 

Clay 

Cloud 

Coffey , 

Comanche .. 

Cowley 

Crawford 

Decatur 

Dickinson... 
Doniphan... 

Douglas 

Edwards 

Elk 

Ellis 

Ellsworth . . . 

Finney 

Ford 

Franklin 

Geary 

•Gove 

Graham 

Grant 

Gray 

Greeley 

Greenwood . 
Hamilton . . . 

Harper 

Harvey 

Haskell 

Hodgeman.. 

Jackson 

Jefferson 

Jewell 

Johnson 

Kearny 

Kingman . . . 
Kiowa 



Cases of leprosy 
reported. 



None. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 



County. 



Cases of leprosy 
reported. 



Labette 

Lane 

Leavenworth 

Lincoln 

Linn 

Logan 

Lyon 

McPherson .. 

Marion 

Marshall 

Meade 

Miami 

Mitchell 

Montgomery . 

Morris 

Morton 

Nemaha 

Neosho 

Ness 

Norton 

Osage 

Osborne 

Ottawa 

Pawnee 

Phillips ...... 

Pottawatomie 

Pratt 

Rawlins 

Reno 

Republic 

Rice 

Riley 

Rooks 

Rush 

Russell 

Saline 

Scott 

Sedgwick 

Seward 

Shawnee 

Sheridan 

Sherman 

Smith 

Stafford 

Stanton 

Stevens 

Sumner 

Thomas 

Trego 



None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

DO. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 



24 



LEPROSY IN THE UNITED STATES. 



Table No. 2. — List of States, arranged alphabetically, showing the presence or absence of 

leprosy in each county — Continued. 



KANSAS— Continued. 



County. 


Cases of leprosy 
reported. 


Countv Cases of le P ros y 
^ oumy - reported. 


Wabaunsee 


None. 
Do. 
Do. 
Do. 


Wilson 


None. 


Wallace 


Woodson 


Do. 


Washington 


Wyandotte 


Do. 


Wichita 











Kansas. — One hundred and five counties. Ninety-eight counties report no cases of leprosy therein. 
Dr. William B. Swan, secretary State board of health, Topeka, says: "So far as this office has any 
knowledge, no leprosy exists in this State at the present time." No report was received from the 
following 7 counties: Bourbon, Crawford, Graham, Hamilton, Jackson, Marshall, and Norton. 

KENTUCKY. 



County. 



Adair 

Allen 

Anderson 

Ballard 

Barren 

Bath 

Bell 

Boone 

Bourbon 

Boyd 

Boyle 

Bracken 

Breathitt 

Breckinridge 

Bullitt 

Butler 

Caldwell 

Calloway 

Campbell 

Carlisle 

Carroll 

Carter 

Casey 

Christian 

Clark 

Clay 

Clinton 

Crittenden . . . 
Cumberland . 

Daviess 

Edmonson . . . 

Elliott 

Estill 

Fayette 

Fleming 

Floyd 

Franklin 

Fulton 

Gallatin 

Garrard 

Grant 

Graves 

Grayson 

Green 

Greenup 

Hancock 

Hardin 

Harlan 

Harrison 

Hart 

Henderson... 

Henry 

Hickman 

Hopkins 

Jackson 

Jefferson 

Jessamine 

Johnson 

Kenton 

Knott 



Cases of leprosy 
reported. 



None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
Suspected cases. 
None. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 



County. 



Knox 

Larue 

Laurel 

Lawrence 

Lee 

Leslie 

Lechter 

Lewis 

Lincoln 

Livingston . . . 

Logan 

Lyon 

McCracken .. 

McLean 

Madison 

Magoffin 

Marion 

Marshall 

Martin 

Mason 

Meade 

Menifee 

Mercer , , 

Metcalf 

Monroe 

Montgomery 

Morgan 

Muhlenberg . 

Nelson , 

Nicholas 

Ohio 

Oldham 

Owen 

Owsley 

Pendleton . . 

Perrv 

Pike 

Powell 

Pulaski 

Robertson... 
Rockcastle . . 

Rowan 

Russell 

Scott 

Shelby 

Simpson 

Spencer 

Taylor 

Todd 

Trigg 

Trimble 

Union 

Warren 

Washington. 

Wayne 

Webster 

Whitley 

Wolfe 

Woodford . . . 



Cases of leprosy 
reported. 



No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
One suspected case. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 

Do. 

Do. 
None. 

Do. 

Do- 
Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 
No report. 
None. 
No report. 
None. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 



Kentucky. — 119 counties. One hundred and four counties report no cases of leprosy therein. 
Grant and Lincoln counties report cases of suspected leprosy. No report was received from the 
following thirteen counties: Clay, Elliott, Grayson, Jackson, Knox, Martin, Mason, Meade, Morgan, 
Owsley, Perry, Powell, and Russell. 



LEPROSY IN THE UNITED STATES. 



25 



Table No. 2. — List of States, arranged alphabetically, showing the presence or absence of 

leprosy in each county — Continued . 

LOUISIANA. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Acadia 


None. 

Do. 
No report. 
None. 
No report. 
None. 

1 suspected case. 
1 case. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
38 cases. 
None. 

1 case. 
No report. 

2 cases. 
None. 

No report. 
None. 

Do. 

Do. 


Orleans 


101 cases. 


Ascension 


Ouachita 


None. 


Assumption . 


Plaquemines 


1 case. 




Pointe Coupee 


No report. 
Do. 


Bienville 


Rapides 


Bossier 


Red River 


None. 


Caddo 


Richland 


Do. 


Calcasieu - 


Sabine 


Do. 


Caldwell 


St. Bernard I Do. 


Cameron 


St. Charles j Do. 


Catahoula 


St. Helena 1 No report. 


Claiborne 


St. James Do. 


Concordia 


St. John the Baptist 1 1 case. 


De Soto 


St. Landry Do. 


East Baton Rouge 


St. Martin \ Do. 


East Carroll 


St. Mary . Do. 


East Feliciana 


St. Tammany Do. 


Franklin 


Tangipahoa None. 


Grant r 


Tenas ! Do. 


Iberia 


Terrebonne Do. 


Iberville 


Union 1 Do. 


Jackson 


Vermilion 3 cases. 


Jefferson 


Vernon No report. 


Lafayette 


Washington i None. 


Lafourche 


Webster i No report. 


Lincoln 


West Baton Rouge None. 


Livingston 


West Carroll 


No report. 

Do. 
None. 


Madison 


West Feliciana 


Morehouse 


Winn 


Natchitoches 











Louisiana. — Fifty-nine counties. Thirty-three counties report no cases of leprosy therein. Cal- 
casieu, Jefferson, Plaquemines, St. John the Baptist, St. Landry, St. Martin, St. Mary, and St. Tam- 
many counties report 1 case each in their respective counties. Thirty-eight cases are reported in 
Iberville County, 37 of which are confined in the leper home at Iberville; 2 cases are reported in 
Lafourche County; 101 cases are reported in Orleans County, and 3 cases in Vermilion County. 
Three more cases are reported in the State; definite location not given. One case of suspected 
leprosy is reported in Caddo County. 

No report has been received from the following 13 counties: Assumption, Bienville, Iberia, Lafay- 
ette, Livingston, Pointe Coupee, Rapides, St. Helena, St. James, Vernon, Webster, West Carroll, and 
West Feliciana. 

MAINE. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Androscoggin 


None. 


Oxford 


None. 


Aroostook 


Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 


Penobscot 


Do. 


Cumberland 


Piscataquis 


Do. 


Franklin 


Sagadahoc 


Do. 


Hancock 


Somerset 


Do. 


Kennebec 


Waldo 


Do. 


Knox 


Washington 


Do. 


Lincoln 


York 


Do. 









Maine.— Sixteen counties. Fifteen counties report no cases of leprosy therein. Dr. A. G. Young, 
secretary State board of health, says: "No leprosy in the State." No report was received from Han- 
cock County. 

MARYLAND. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Allegany 


None. 

Do. 

Do. 
1 case. 
None. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 


Harford 


None. 


Anne Arundel 


Howard 


Do. 


Baltimore 


Kent 


Do. 


Baltimore City. 


Montgomery 


Do. 


Calvert 


Prince George 


Do. 


Caroline 


Queen Anne 


Do. 


Carroll- 


St. Mary.. 


Do. 


Cecil 


Somerset 


Do. 


Charles 


Talbot 


Do. 


Dorchester 


Washington 


Do. 


Frederick 


Wicomico 


Do. 


Garrett 


Worcester 


Do. 









Maryland. — Twenty-four counties. Twenty-two counties report no cases of leprosy therein; Balti- 
more City County reports one case of leprosy. No report was received from Charles County. 



26 



LEPEOSY IN THE UNITED STATES. 



Table No. 2. — List of States, arranged alphabetically, showing the presence or absence of 

leprosy in each county — Continued. 

MASSACHUSETTS. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Barnstable 


None. 

Do. 

Do. 

Do. 

Do. 

Do. 
1 case. 


Hampshire 


None. 


Berkshire 


Middlesex 


1 case. 


Bristol 


Nantucket 


None. 


Dukes 


Norfolk 


Do. 


Essex 


Plymouth 


Do. 


Franklin 


Suffolk 


Do. 


Hampden 


Worcester 


Do. 









Massachusetts.— Fourteen counties. Twelve counties report no cases of leprosy therein, 
den and Middlesex counties report one case of leprosy each. 



Hamp- 



MICHIGAN. 



County. 



Alcona 

Alger 

Allegan 

Alpena 

Antrim 

Arenac 

Baraga 

Barry 

Bay 

Benzie 

Berrien 

Branch 

Calhoun 

Cass 

Charlevoix 

Cheboygan 

Chippewa 

Clare 

Clinton 

Crawford 

Delta 

Dickinson 

Eaton 

Emmet 

Genesee 

Gladwin 

Gogebic 

Grand Traverse 

Gratiot 

Hillsdale 

Houghton 

Huron 

Ingham 

Ionia 

Iosco 

Iron 

Isabella 

Jackson 

Kalamazoo 

Kalkaska 

Kent 

Keweenaw 



Cases of leprosy 
reported. 



None: 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 



County. 



Lake 

Lapeer 

Leelanaw 

Lenawee 

Livingston . . . 

Luce 

Mackinac 

Macomb 

Manistee 

Marquette 

Mason 

Mecosta 

Menominee .. 

Midland 

Missaukee 

Monroe 

Montcalm 

Montmorency 

Muskegon 

Newaygo 

Oakland 

Oceana 

Ogemaw 

Ontonagon . . . 

Osceola 

Oscoda 

Otsego 

Ottawa 

Presque Isle . . 
Roscommon . . 

Saginaw 

St. Clair 

St. Joseph 

Sanilac 

Schoolcraft. . . 
Shiawassee . . . 

Tuscola 

Van Buren . . . 
Washtenaw .. 

Wayne 

Wexford 



Cases of leprosy 
reported. 



None. 

Do. 

Do. 

Do. 
No report. 
None. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 



Michigan. —Eighty-three counties. Seventy-nine counties report no cases of leprosy therein. Dr. 
Henry B. Baker, secretary State board of health, says: " There is no case of leprosy in Michigan." No 
report was received from the following four counties: Livingston, Mackinac, Oakland, and Tuscola. 

MINNESOTA. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Aitkin 


None. 
Do. 
Do. 
Do. 
Do. 




None. 


Anoka 


Blue Earth 


Do. 


Becker 


Brown 


1 case. 


Beltrami 


Carlton 


None. 


Benton 




Do. 



LEPROSY IN THE UNITED STATES. 



27 



Table No. 2. — List of States, arranged alphabetically, showing the presence or absence of 

leprosy in each county — Continued. 



MINNESOTA— Continued. 



Countv, 



Cass 

Chippewa 

Chisago 

Clay 

Cook 

Cottonwood.. 
Crow Wing... 

Dakota 

Dodge 

Douglas 

Faribault 

Fillmore 

Freeborn 

Goodhue 

Grant 

Hennepin 

Houston 

Hubbard 

Isanti 

Itasca 

Jackson 

Kanabec 

Kandiyohi... 

Kittson 

Lac Qui Parle 

Lake 

Lesueur 

Lincoln 

Lyon 

McLeod 

Marshall 

Martin 

Meeker 

Millelacs 

Morrison 

Mower 



Cases of leprosy 
reported. 



County. 



None. 
1 case. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
1 case. 
None. 

Do. 

Do. 

Do. 
4 cases. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 
1 case 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
1 case. 
None. 

Do. 

Do. 

Do. 

Do. 



Murray 

Nicollet 

Nobles 

Norman 

Olmsted 

Ottertail 

Pine 

Pipestone 

Polk 

Pope 

Ramsey 

Red Lake 

Redwood 

Renville 

Rice 

Rock 

Roseau 

St. Louis 

Scott 

Sherburne 

Sibley 

Stearns 

Steele 

Stevens 

Swift 

Todd 

Traverse 

Wabasha 

Wadena 

Waseca 

Washington 

Watonwan 

Wilkin 

Winona 

Wright 

Yellow Medicine 



Cases of leprosy 
reported. 



None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
3 cases. 
1 case. 
None. 

Do. 

Do, 

Do. 

Do. 

Do. 

Do. 
1 case. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
1 case. 
None. 

Do. 

Do. 

Do. 



Minnesota. — Eighty-two counties. Seventy-two counties are reported to be free from leprosy; the 
disease existing in 10 counties as follows: Brown, 1 case; Chippewa, 1 case; Faribault, 1 case; Hen- 
nepin, 4 cases; Kandiyohi, 1 case; Marshall, 1 case; Polk, 3 cases; Pope, 1 case; St. Louis, 1 case; 
Watonwan, 1 case. There are 5 additional cases of leprosy in the State which are not definitely 
located. 

MISSISSIPPI. 



County. 


Cases of leprosy 
reported. 


r nln ntv ' Cases of leprosy 
Count > • reported. 


Adams 


No report. 
None. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 
3 cases. 
None. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 


Jones 


No report. 
None. 


Alcorn 


Kemper 


Amite 


Laf avette 


Do. 


Attala 


Lauderdale 


No report. 
None. 


Benton 


Lawrence 


Bolivar 


Leake 


Do. 


Calhoun 


Lee 


No report. 
Do. 


Carroll 


Leflore 


Chickasaw 


Lincoln 


None. 


Choctaw 


Lowndes 


Do. 


Claiborne 


Madison 


Do. 


Clarke 


Marion 


No report. 
None. 


Clay 


Marshall 


Coahoma 


Monroe 


Do. 


Copiah 


Montgomery 


Do. 


Covington 


Neshoba 


Do. 


De Soto 


Newton 


Do. 


Franklin 


Noxubee 


Do. 


Greene 


Oktibbeha 


Do. 


Grenada 


Panola 


Do. 


Hancock 


Pearl River 


Do. 


Harrison 


Perrv 


No report. 
None. 


Hinds 


Pike". 


Holmes 


Pontotoc 


No report. 
Do. 


Issaquena 


Prentiss 


Itawamba 


Quitman 


None. 


Jackson 


Rankin 


Do. 


Jasper 


Scott 


Do. 


Jefferson 


Sharkev 


Do. 



28 



LEPEOSY IN THE UNITED STATES. 



Table No. 2. — List of States, arranged alphabetically, showing the presence or absence of 

leprosy in each county — Continued. 



MISSISSIPPI— Continued. 



County. 


Cases of leprosy- 
reported. 


County. 


Cases of leprosy 
reported. 


Simpson 


No report. 

Do. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 


Warren 


No report. 
Do. 


Smith 


Washington 


Sunflower 


Wayne 


None. 


Tallahatchie 


Webster 


Do. 


Tate 


Wilkinson 


2 cases. 


Tippah 


Winston 


No report. 

None. 


Tishomingo 


Yalobusha 


Tunica 


Yazoo 


Do. 


Union 











Mississippi.— Seventy-five counties. Fifty-five counties report no cases of leprosy therein. Harrison 
County reports 3 cases and Wilkinson County 2 cases. No report was received from the following IS 
counties: Adams, Calhoun, Chickasaw, Covington, Itawamba, Jones, Lauderdale, Lee, Leflore, 
Marion, Perry, Pontotoc, Prentiss, Simpson, Smith, Warren, Washington, and Winston. 

MISSOURI. 




Adair 

Andrew 

Atchison 

Audrain 

Barry 

Barton 

Bates 

Benton 

Bollinger 

Boone 

Buchanan 

Butler 

Caldwell 

Callaway 

Camden 

Cape Girardeau . 

Carroll 

Carter 

Cass 

Cedar , 

Chariton 

Christian 

Clark 

Clay 

Clinton 

Cole 

Cooper 

Crawford , 

Dade 

Dallas 

Daviess . 

Dekalb 

Dent 

Douglas 

Dunklin 

Franklin 

Gasconade 

Gentry 

Greene 

Grundy 

Harrison 

Henry 

Hickory 

Holt 

Howard 

Howell 

Iron 

Jackson 

Jasper 

Jefferson 

Johnson 

Knox 

Laclede 

Lafayette 



None. 
No report. 
None. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 



Lawrence 

Lewis 

Lincoln 

Linn 

Livingston . . . 
McDonald ... 

Macon 

Madison 

Maries 

Marion 

Mercer 

Miller 

Mississippi . . . 

Moniteau 

Monroe ...... 

Montgomery . 

Morgan 

New Madrid . 

Newton 

Nodaway 

Oregon 

Osage 

Ozark 

Pemiscot 

Perry 

Pettis 

Phelps 

Pike 

Platte 

Polk 

Pulaski 

Putnam 

Ralls 

Randolph 

Ray : 

Reynolds 

Ripley 

St. Charles . . . 

St. Clair 

St. Genevieve 
St. Francois.. 

St. Louis 

St. Louis City 

Saline 

Schuyler 

Scotland 

Scott 

Shannon 

Shelby 

Stoddard 

Stone 

Sullivan 

Taney 

Texas 



None. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 
5 cases. 
None. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 



LEPROSY IN THE UNITED STATES. 



29 



Table No. 2. — List of States, arranged alphabetically, showing the presence or absence of 

leprosy in each county — Continued. 



MISSOURI— Continued. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 




None. 
Do. 
Do. 
Do. 


Webster 


None. 




Worth 


Do. 




Wright 


Do. 


Wayne 











Missouri. — One hundred and fifteen counties. One hundred and five counties report no cases of 
leprosy therein. St. Louis City County reports 5 cases of leprosy. No report was received from the 
following 9 counties: Andrew, Bates, Carroll, Douglas, Knox, Lincoln, St. Clair, Scotland, and Stone. 

MONTANA. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Beaverhead 


None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 


Jefferson 


None. 


Broadwater 


Lewis and Clarke 


Do. 


Carbon 


i Madison 


Do. 


Cascade 


Meagher 


Do. 


Choteau 


Missoula 


One case. 


Crow Reservation 


Park 


None. 


Custer 


Ravalli 


Do. 


Dawson 


Silverbow 


Do. 


Deerlodge 


Sweet Grass 


Do. 


Fergus 


Teton 


Do. 


Flathead 


Vallev 


No report. 
None. 


Gallatin 


Yellowstone 


Granite 











Montana.— Twenty-five counties. Twenty-two counties report no cases of leprosy therein. One 
•case of leprosy is reported in Missoula County. No report was received from Gallatin and Valley 
•counties. 

NEBRASKA. 



County. 


Cases of leprosy I 
reported. 


County. 


Cases of leprosy 
reported. 


Adams 


None. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
None. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 


Greelev 


None. 


Antelope 


Hall 


Do. 


Banner 


Hamilton 


Do. 


Blaine 


Harlan 


Do. 


Boone 


Hayes 


No report. 
None. 


Boxbutte 


Hitchcock 


Boyd 


Holt 


Do. 


Brown 


Hooker 


Do. 


Buffalo 


Howard . . 


Do. 


Burt 


Jefferson 

Johnson 


Do. 


Butler 


Do. 


Cass 


Kearnev 


Do. 


Cedar 


Keith 


Do. 


Chase 


Kevapaha 


Do. 


Cherrv 


Kimball 


Do. 


Chevenne 


Knox 


Do. 


Clav 


Lancaster 


Suspected case. 
None. 


Colfax 


Lincoln 


Cuming 


Logan 


Do. 


Custer 


Loup 


Do. 


Dakota 


McPherson 


Do. 


Dawes 


Madison 


Do. 


Dawson 


Merrick 


Do. 


Deuel 


Nance 


Do. 


Dixon 


Nemeha 


Do. 


Dodge 


Nuckolls 


Do. 


Douglas 


Otoe 


Do. 


Dundv 


Pawnee 


Do. 


Fillmore 


Perkins 


Do. 


Franklin 


Phelps 


Do. 


Frontier 


Pierce 


Do. 


Furnas 


Platte 


Do. 


Gage 


Polk 


Do. 


Garfield 


Redwillow 


Do. 


Gosper 


Richardson 


Do. 


Grant 


Rock 


Do. 



30 



LEPKOSY IN THE UNITED STATES. 



Table No. 2. — List of States, arranged alphabetically, showing the presence or absence of 

leprosy in each county — Continued. 



NEBRASKA— Continued. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Saline 


No report. 
None. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 


Thayer 


None. 


Sarpy 


Thomas 


Do. 


Saunders 


Thurston 


No report. 
None. 


Scotts Bluff 


Valley 


Seward 


Washington 


Do. 


Sheridan 


Wavne 


Do. 


Sherman 


Webster 


Do. 


Sioux 


Wheeler 


Do. 


Stanton 


York 


Do. 









Nebraska.— Ninety counties. Eighty- two counties report no cases of leprosy therein; one case of 
suspected leprosy is reported in Lancaster County. No report was received from the following seven 
counties: Boyd, Cuming, Fillmore, Hayes, Saline, Seward, and Thurston. 

NEVADA. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Churchill 


None. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 


Lincoln 


None. 


Douglas 


Lyon 


One case. 


Elko 


Nye 


None. 


Esmeralda 


Ormsby 


Do. 


Eureka 


Storey 


Do. 


Humboldt 


Washoe 


Do. 


Lander 


White Pine 


Do. 









Nevada. — Fourteen counties. Thirteen counties report no cases of leprosy therein. One case of 
leprosy in Lyon County. 



NEW HAMPSHIRE. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Belknap 


None. 
Do. 
Do. 
Do. 
Do. 


Hillsboro 


None. 


Carroll 


Merrimack 


Do. 


Cheshire 


Rockingham 


Do. 


Coos 


Strafford 


Do. 


Grafton 


Sullivan 


Do. 









New Hampshire.— Ten counties. Reports have been received from all the counties in New Hamp- 
shire, and no cases or suspected cases of leprosy are reported. 

NEW JERSEY. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Atlantic 


None. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 


Middlesex 


No report. 


Bergen 


Monmouth 


None. 


Burlington 


Morris 


Do. 


Camden 


Ocean 


No report. 


Cape May 


Passaic 


None. 


Cumberland 


Salem 


Do. 


Essex 


Somerset 


Do. 


Gloucester 


Sussex 


Do. 


Hudson 


Union 


Do. 


Hunterdon 


Warren 


Do. 


Mercer 











New Jersey.— Twenty-one counties. Nineteen counties report no cases of leprosy therein, 
dlesex and Ocean counties do not report. 



Mid- 



LEPBOSY IN THE UNITED STATES. 



31 



Table No. 2. — List of States, arranged alphabetically, showing the presence or absence of 

leprosy in each county — Continued. 



NEW MEXICO. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Bernalillo 


None. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 


Rio Arriba 


No renort. 


Chaves 


San Juan None. 


Colfax 


San Miguel 


Do. 
Do. 
Do. 




Santa Fe 


Eddy. 


Sierra 


Grant . 


Socorro ' Do. 


Guadalupe 


Taos Do, 


Lincoln 


None. 
Do. 
Do. 


Union No report. 




Valencia None. 


Otero 











New Mexico. — Nineteen counties. Reports received from 16 counties indicate the absence of lep- 
rosy therein. No report received from the following counties: Guadalupe. Rio Arriba, and Union. 

NEW YORK. 



County. 


Cases* of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Albanv 


None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 
4 cases. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 
3 cases. 
None. 


Oneida 


None. 


Allegany 


Onondaga 


Do. 


Broome 


Ontario 


Do. 


Cattaraugus 


Orange 


Do. 


Cayuga 


Orleans 


Do. 


Chautauqua 


Oswego 


Do. 


Chemung 


Otsego 


Do. 


Chenango 


Putnam 


Do. 


Clinton 


Queens 


Do. 


Columbia 


Rensselaer 


Do. 


Cortland 


Richmond 


Do. 


Delaware 


Rockland 


Do. 


Dutchess 


St. Lawrence 


Do. 


Erie 


Saratoga 


Do. 


Essex 


Schenectady 


Do. 


Franklin 


Schoharie 


Do. 


Fulton 


Schuvler 


Do. 


Genesee 


Seneca 


Do. 


Greene 


Steuben 


Do. 


Hamilton 


Suffolk 


Do. 


Herkimer 


Sullivan 


Do. 


Jefferson 


Tioga 


Do. 


Kings 


Tompkins . . 


Do. 


Lewis 


Ulster 


Do. 


Livingston 


Warren 


Do. 


Madison 


Washington 


Do. 


Monroe 


Wavne .. 


No report. 
None. 


Montgomery 


Westchester 


Nassau 


Wvominsr 


Do. 


New York 


Yates 


Do. 


Niagara 











New York.— Sixty-one counties. Fifty-seven counties report no cases of leprosy. Four cases of the 
disease are reported in Kings County, and three cases in New York County. Herkimer and Wayne 
counties do not report. 

NORTH CAROLINA. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Alamance 


None. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 


Carteret 


None. 


Alexander 


Caswell 


Do. 


Alleghany 


Catawba 


No report. 
None. 


Anson 


Chatham . 


Ashe 


Cherokee 


Do. 


Beaufort 


Chowan 


Do. 


Bertie 


Clay . . 


Do. 


Bladen 


Cleveland 


Do. 


Brunswick 


Columbus 


Do. 


Buncombe 


Craven . 


Do. 


Burke 


Cumberland 


Do. 


Cabarrus 


Currituck . 


Do. 


Caldwell.... 


Dare 


Do. 




Davidson 


Do. 



:32 



LEPEOSY IN THE UNITED STATES. 



Table No. 2. — List of States, arranged alphabetically, shotting the presence or absence of 

leprosy in each county — Continued. 



NORTH CAROLINA— Continued. 



County. 


Cases of leprosy 
reported. 


Countjr. 


Cases of leprosy 
reported. 


Davie 


None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 


Northampton . 


None 


Duplin 


Onslow 


Do. 


Durham 


Orange 


Do. 


Edgecombe 


Pamlico 


Do. 


Forsyth 


Pasquotank 


Do. 


Franklin 


Pender 


Do. 


Gaston 


Perquimans 


Do. 


Gates 


Person 


Do. 


Graham 


Pitt 


Do. 


Granville 


Polk 


Do. 


Greene 


Randolph -. 


Do. 


Guilford 


Richmond 


No report. 
None 


Halifax 


Robeson 


Harnett 


Rockingham 


Do. 


Haywood 


Rowan 


No report. 
None. 


Henderson 


Rutherford 


Hertford 


Sampson 


Do. 


Hyde 


Stanly 


Do. 


Iredell 


Stokes 


Do. 


Jackson 


Surry 


No report. 
None. 


Johnston 


Swain 


Jones 


Transvlvania 


No report. 
None. 


Lenoir 


Tvrrell 


Lincoln 


Union 


Do. 


McDowell 


Vance 


Do. 


Macon 


Wake 


Do. 


Madison 


Warren 


Do. 


Martin 


Washington 


Do. 


Mecklenburg 


Watauga 


Do. 


Mitchell 


Wavne 


Do. 


Montgomery 


Wilkes 


Do. 


Moore 


Wilson 


Do. 


Nash 


Yadkin 


Do. 


New Hanover 


Yancey 


No report. 







North Carolina.— Ninety-six counties. Eighty-five counties report no cases of leprosy therein. 
No report was received from the following eleven counties: Anson, Camden, Catawba, Graham, Hay- 
wood, Lincoln, Richmond, Rowan, Surry, Transylvania, and Yancey. 

NORTH DAKOTA. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Barnes 


None. 

Do. 

Do. 

Do. 
1 case. 
None. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do, 

Do. 

Do. 

Do. 

Do. 


Morton 


None. 


Benson 


Nelson 


Do. 


Billings 


Oliver 


Do. 


Bottineau 


Pembina 


6 cases. 


Burleigh 


Pierce 


No report. 


Cass 


Ramsey 


Do. 


Cavalier 


Ransom 


None. 


Dickey 


Richland 


Do. 


Eddy 


Rolette 


Do. 


Emmons 


Sargent 


Do. 


Foster 


Stark 


Do. 


Grand Forks 


Steele 


Do. 


Griggs 


Stutsman 


Do. 


Kidder 


Towner 


No report. 


Lamoure 


Traill 


None. 


Logan 


Walsh 


8 cases. 


McHenry 


Ward 


None. 


Mcintosh 


Wells 


Do. 


McLean 


Williams 


Do. 


Mercer 











North Dakota. — Thirty-nine counties. Thirty-two counties report no cases of leprosy therein. 
•One case of leprosy is reported in Burleigh County, 6 cases in Pembina County, and 8 cases in Walsh 
County. No report was received from the following counties: Emmons, Pierce, Ramsey, and Towner. 



LEPROSY IN THE UNITED STATES. 



33 



Table No. 2. — List of States, arranged alphabetically, showing the presence or absence of 

leprosy in each county — Continued. 



OHIO. 



County. 



Adams 

Allen 

Ashland . . . 
Ashtabula . 

Athens 

Auglaize . . . 
Belmont . . . 

Brown 

Butler 

Carroll 

Champaign 

Clark 

Clermont . . 

Clinton 

Columbiana 
Coshocton.. 
Crawford... 
Cuyahoga . . 

Darke 

Defiance 

Delaware . . 

Erie 

Fairfield . . . 

Fayette 

Franklin... 

Fulton 

Gallia 

Geauga 

Greene 

Guernsey . . 
Hamilton . . 
Hancock... 

Hardin 

Harrison 

Henry 

Highland . . 
Hocking 

Holmes 

Huron 

Jackson 

Jefferson. ... 

Knox 

Lake 

Lawrence . . . 



Cases of leprosy 
reported. 



None. 

Do. 
No report. 
None. 
No report. 

Do. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 



County. 



Licking 

Logan 

Lorain 

Lucas 

Madison 

Mahoning .. 

Marion 

Medina 

Meigs 

Mercer 

Miami 

Monroe 

Montgomery 

Morgan 

Morrow 

Muskingum. 

Noble 

Ottawa 

Paulding . . . 

Perry 

Pickaway . . . 

Pike 

Portage 

Preble 

Putnam 

Richland ... 

Ross 

Sandusky . . . 

Scioto 

Seneca 

Shelbv 

Stark' 

Summit 

Trumbull . . . 
Tuscarawas . 

Union 

Van Wert . . . 

Vinton 

Warren 

Washington . 

Wayne 

Williams 

Wood 

Wyandot 



Cases of leprosy 
reported. 



None. 

Do. 

Do. 

Do. 

Do. 
No report. 

Do. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 
No report. 
None. 

1 suspected case. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 



Ohio.— Eighty-eight counties. Seventy-eight counties report no cases of leprosy therein. One case 
of suspected leprosy is reported in Perry County. The following counties have not reported: Ashland, 
Athens, Auglaize, Knox, Mahoning, Marion, Muskingum, Ottawa, Tuscarawas. 

OKLAHOMA. 



County. 



Beaver 

Blaine 

Canadian 

Cleveland 

Custer 

Day 

Dewey 

Garfield 

Grant 

Greer 

Kansas Nation 

Kay 

Kingfisher 



Cases of leprosy 
reported. 



None. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 
No report. 



County. 



Kiowa and Comanche nations 

Lincoln 

Logan 

Noble 

Oklahoma 

Osage Nation 

Pawnee 

Payne 

Pottawatomie 

Roger Mills 

Washita 

Woods 

Woodward 



Cases of leprosy 
reported. 



None. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 



Oklahoma. — Twenty-six counties. Twenty-four counties report no cases of leprosy therein, 
following counties have not reported: Dewey and Kingfisher. 

S. Doc. 269 3 



The 



34 



LEPROSY IN THE UNITED STATES. 



Table No. 2. — List of States, arranged alphabetically, shoving the presence or absence of 

leprosy in each county — Continued. 



OREGON. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Baker 


No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 


Lincoln 




Benton 


Linn 


Do 


Clackamas 


Malheur 


Do 


Clatsop 


Marion 


Do 


Columbia 


Morrow 


Do 


Coos 


Multnomah 




Crook 


Polk 


No report. 


Curry 


Sherman . 


Douglas 


Tillamook . . 


Do 


Gilliam 


Umatilla 


Do 


Grant 


Union 


Do 


Harney 


Wallowa 


Do 


Jaekson 


Wasco 


No report. 
None. 


Josephine 


Washington 


Klamath 


Wheeler 


Do 


Lake 


Yamhill 


No report. 


Lane 









Oregon. — Thirty-three counties. Twenty-eight counties report no cases of leprosy therein. One 
case of leprosy is reported in Multnomah County. No report was received from the" following four 
counties: Baker, Polk, Wasco, and Yamhill. 

PENNSYLVANIA. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Adams 


None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 


Lackawanna 


None. 


Allegheny 


Lancaster 


Do. 


Armstrong 


Lawrence 


Do. 


Beaver 


Lebanon 


Do. 


Bedford 


Lehigh 


Do. 


Berks 


Luzerne 


Do. 


Blair 


Lvcoming 


Do. 


Bradford 


McKean 


Do. 


Bucks 


Mercer 


Do. 


Butler 


Mifflin 


Do. 


Cambria 


Monroe 


Do. 


Cameron 


Montgomery 


Do. 


Carbon 


Montour 


Do. 


Center 


Northampton 


Do. 


Chester 


Northumberland 


Do. 


Clarion 


Perry 


Do. 


Clearfield 


Philadelphia 


1 case. 


Clinton 


Pike 


None. 


Columbia 


Potter 


Do. 


Crawford 


Schuylkill 


Do. 


Cumberland 


Snyder 


Do. 


Dauphin 


Somerset 


No report. 
None. 


Delaware 


Sullivan 


Elk 


Susquehanna 


Do. 


Erie 


Tioga 


No report. 


Fayette 


Union 


None. 


Forest 


Venango 


Do. 


Franklin 


Warren 


Do. 


Fulton 


Washington 


Do. 


Greene 


Wavne '. 


Do. 


Huntingdon 


Westmoreland 


Do. 


Indiana 


Wyoming 


Do. 


Jefferson 


York 


Do. 


Juniata 











Pennsylvania.— Sixty-seven counties. Sixty-three counties report no cases of leprosy therein. 
One case of leprosy is reported in Philadelphia County. The following counties have not reported: 
Huntingdon, Somerset, and Tioga. 



LEPROSY IN THE UNITED STATES. 



35 



Table No. 2. — List of States, arranged alphabetically, shovnng the presence or absence of 

leprosy in each county — Continued. 



RHODE ISLAND. 



County. 


.Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Bristol . 


None. 
Do. 
Do. 


Providence 


None. 


Kent 


Washington 


Do. 


Newport 











Rhode Island. — Five counties. No cases of leprosy reported. 

SOUTH CAROLINA. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Abbeville 


None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 
No report. 


Greenwood 


None. 


Aiken 


Hampton 


Do. 


Anderson 


Horrv 


Do. 


Bamberg 


Kershaw 


Do. 


Barnwell 


Lancaster 


Do. 


Beaufort 


Laurens 


No report. 
None. 


Berkeley 


Lexington 


Charleston 


Marion 


Do. 


Cherokee 


Marlboro 


Do. 


Chester 


Newberrv 


Do. 


Chesterfield 


Oconee 


Do. 


Clarendon 


Orangeburg 


Do. 


Colleton 


Pickens 


Do. 


Darlington 


Richland 


No report. 
None. 


Dorchester 


Saluda 


Edgefield 


Spartanburg 


Do. 


Fairfield 


Sumter 


Do. 


Florence 


Union 


No report. 
None. 


Georgetown 


Williamsburg 


Greenville 


York 


Do. 









South Carolina.— Forty counties. Thirty-five counties report no cases of leprosy therein. Cases 
of leprosy have existed in Charleston County, but reports received indicate the absence of the disease 
in that county at the present time. The following counties have not reported: Florence, Greenville, 
Laurens, Richland, and Union. 

SOUTH DAKOTA. 



County. 


Cases of leprosy, 
reported. 


County. 


Cases of leprosy 
reported. 


Aurora 


None. 

Do. 
No report. 

Do. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 
No report. 
None. 

Do. 

Do. 
1 case. 
None. 

Do. 

Do. 

Do. 
No report. 
None. 
No report. 
None. 

Do. 

Do. 
No report. 
None. 

Do. 


Hughes 


None. 


Beadle 


Hutchinson 


Do. 


Bonhomme 


Hvde 


Do. 


Boreman 


Jackson 


Do. 


Brookings 


Jerauld 


Do. 


Brown 


Kingsburv 


No report. 
None. 


Brule 


Lake 


Buffalo 


Lawrence 


Do. 


Butte 


Lincoln 


Do. 


Campbelll 


Lvman 


No report. 
None. 


Charles Mix 


McCook 


Choteau 


McPherson 


Do. 


Clark 


Marshall 


Do. 


Clav 


Meade 


Do. 


Codington 


Mever 


Do. 


Custer 


Miner 


No report. 


Davison 


Minnehaha 


None. 


Dav 


Moody 


Do. 


Deuel 


Nowlin 


No report. 


Dewey 


Pennington 


None. 


Douglas 


Potter 


Do. 


Edmunds 


Pratt 


No report. 


Ewing 


Presho 


Do. 


Fall River 


Roberts 


None. 


Faulk 


Sanborn 


Do. 


Grant 


Scobev 


No report. 
None. 


Gregory 


Shannon 


Hamlin 


Spink 


Do. 


Hand 


Stanle v 


Do. 


Hanson 


Sterling 


Do. 


Harding 


Sully 


Do. 



36 



LEPROSY IN THE UNITED STATES. 



Table No. 2. — List of States, arranged alphabetically, showing the presence or absence of 

leprosy in each county — Continued. 



SOUTH DAKOTA— Continued. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Turner 


None. 
Do. 

No report. 
None. 


Washabaugh 


None. 


Union 


Yankton 


Do. 


Wagner 


; Ziebach 


No report. 


Walworth 


i 

< 









South Dakota. — Sixty-nine counties. Fifty-two counties report no cases of leprosy therein. One 
case of leprosy reported in Day County. The following counties have not reported: Bonhomme, Bore- 
man, Choteau, Clay, Ewing, Faulk, Hand, Kingsbury, Lyman, Miner, Nowlin, Pratt, Presho, Scobey, 
Wagner, and Ziebach. 

TENNESSEE. 



County. 



Anderson . . . 

Bedford 

Benton 

Bledsoe 

Blount 

Bradley 

Campbell .. 

Cannon 

Carroll 

Carter 

Cheatham .. 

Chester 

Claiborne . . . 

Clay 

Cocke 

Coffee 

Crockett 

Cumberland 
Davidson ... 

Decatur 

Dekalb 

Dickson 

Dyer , 

Fayette 

Fentress 

Franklin 

Gibson 

Giles 

Grainger 

Greene 

Grundy 

Hamblen ... 
Hamilton . . . 

Hancock 

Hardeman . . 

Hardin 

Hawkins 

Haywood . . . 
Henderson . . 

Henry 

Hickman . . . 
Houston 
Humphreys . 

Jackson 

James 

Jefferson 

Johnson 

Knox 



Cases of leprosy 
reported. 



None. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 



County. 



Lake 

Lauderdale. 
Lawrence .. 

Lewis , 

Lincoln 

Loudon 

McMinn 

McNairy 

Macon 

Madison 

Marion 

Marshall 

Maury 

Meigs 

Monroe 

Montgomery 

Moore 

Morgan 

Obion 

Overton 

Perry 

Pickett 

Polk 

Putnam 

Rhea 

Roane 

Robertson . . . 
Rutherford . , 

Scott 

Sequatchie . , 

Sevier 

Shelby 

Smith 

Stewart 

Sullivan 

Sumner 

Tipton 

Trousdale . . . 

Unicoi 

Union 

Van Buren . . 

Warren 

Washington . 

Wayne 

Weaklev 

White 

Williamson.. 
Wilson 



Cases of leprosy, 
reported. 



None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 



Tennessee. — Ninety-six counties. Eighty-six counties report no cases of leprosy therein. No report 
was received from the following counties: Bedford, Claiborne, Dyer, Hardin, Henry. Knox, Macon, 
Smith, Union, and Wayne. 



LEPROSY IN THE UNITED STATES. 



37 



Table No. 2. — List of States, arranged alphabetically, showing the presence or absence of 

leprosy in each county — Continued. 



TEXAS. 



Countv. 



Anderson 

Angelina 

Aransas 

Archer 

Armstrong 

Atascosa 

Austin 

Bandera 

Bastrop 

Baylor 

Bee 

Bell 

Bexar 

Blanco 

Borden 

Bosque 

Bowie 

Brazoria 

Brazos 

Brewster 

Briscoe 

Brown 

Burleson 

Burnet 

Caldwell 

Calhoun 

Callahan 

Cameron 

Camp 

Carson 

Cass 

Castro 

Chambers 

Cherokee 

Childress 

Clay 

Coke 

Coleman 

Collin 

Collingsworth. 

Colorado 

Comal 

Comanche 

Concho 

Cooke 

Coryell 

Cottle 

Crockett 

Crosby 

Dallam 

Dallas 

Dawson 

Deaf Smith . . . 

Delta 

Denton 

Dewitt 

Dickens 

Dimmit 

Donley 

Duyal 

Eastland 

Ector 

Edwards 

Ellis 

El Paso 

Erath 

Falls 

Fannin 

Fayette ....... 

Fisher 

Floyd 

Foard 

Fort Bend 

Franklin 

Freestone 

Frio 

Galveston 

Gillespie 

Glasscock 



Cases of leprosy 
reported. 



None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do.~ 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
Two cases. 
None. 

Do. 



County. 



Goliad 

Gonzales 

Gray 

Grayson 

Gregg 

Grimes 

Guadalupe .. 

rlale 

Hall 

Hamilton 

Hansford 

Hardeman . . 

Hardin 

Harris 

Harrison 

Hartley 

Haskell 

Hays 

Hemphill 

Henderson . . 

Hidalgo 

Hill 

Hood 

Hopkins 

Houston 

Howard 

Hunt 

Hutchinson . 

Irion 

Jack 

Jackson 

Jasper 

Jeff Davis 

Jefferson 

Johnson 

Jones 

Karnes 

Kaufman 

Kendall 

Kent 

Kerr. 

Kimble 

King 

Kinney 

Knox 

Lamar 

Lampasas . . . 

Lasalle 

Lavaca 

Lee 

Leon 

Liberty 

Limestone . . . 

Lipscomb 

Liveoak 

Llano 

Lubbock 

Lvnn 

McCulloch .. 
McLennan .. 
McMullen . . . 

Madison 

Marion 

Martin 

Mason 

Matagorda .. 

Maverick 

Medina 

Menard 

Midland 

Milan 

Mills 

Mitchell 

Montague . . . 
Montgomery 

Moore 

Morris 

Motley 

Nacogdoches 



Cases of leprosy 
reported. 



None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
1 case. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 



38 



LEPEOSY IN THE UNITED STATES. 



Table No. 2. — List of States, arranged alphabetically, showing the presence or absence of 

leprosy in each county — Continued. 

TEXAS— Continued. 



County. 



Navarro 

Newton 

Nolan 

Nueces 

Ochiltree 

Oldham 

Orange 

Palo Pinto 

Panola 

Parker 

Parmer 

Pecos 

Polk 

Potter 

Presidio 

Rains 

Randall 

Red River 

Reeves 

Refugio 

Roberts 

Robertson 

Rockwall 

Runnels 

Rusk 

Sabine 

San Augustine 
San Jacinto... 
San Patricio . . 

San Saba 

Schleicher 

Scurry 

Shackelford .. 

Shelby . : 

Sherman 

Smith 



Cases of leprosy 
reported. 



None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
None. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 



County. 



Somervell 

Starr 

Stephens 

Sterling 

Stonewall 

Sutton 

Swisher 

Tarrant 

Taylor 

Throckmorton 

Titus 

Tom Green 

Travis 

Trinity 

Tyler 

Upshur 



Cases of leprosy 
reported. 



No report. 
None. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 



Uvalde i None. 



Valverde 
Van Zandt . 

Victoria 

Walker 

Waller 

Ward 

Washington 

Webb.. 

Wharton . . . 

Wheeler 

Wichita 

Wilbarger . . 
Williamson. 

Wilson 

Wise 

Wood 

Young 

Zapata 

Zavalla 



Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 



Note. — Only those counties having a post-office are listed above. 

Texas. — Two hundred and thirty counties. Two hundred and fourteen counties report no cases 
of leprosy therein. Two cases of leprosy are reported in Galveston County and one case in Mave- 
rick County. The following fourteen counties failed to make a report: Caldwell, Cooke, Dawson, 
Jackson, Lynn, Matagorda, Parmer, Presidio, Runnels, Smith, Somervell, Stephens, Upshur, and 
Young. 

UTAH. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Beaver 


None. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 


Rich 

Salt Lake 


None. 


Boxelder 


No report. 
None. 


Cache 


San Juan . 

Sanpete 

Sevier 

Summit 


Carbon 


Do. 


Davis 


Do. 


Emery 


Do. 


Garfield 


Tooele 


Do. 


Grand 


Uinta 

Utah 


Do. 


Iron 


Do. 


Juab 


Wasatch 


Do. 


Kane 


Washington 

Wayne 


Do. 


Millard 


Do. 


Morgan 


Weber 


Do. 


Piute 











Utah. — Twenty-seven counties. Twenty-five counties report no cases of leprosy therein. No 
report received from Carbon and Salt Lake counties. Several cases of leprosy have existed in Tooele 
County among a settlement of Kanakas at Skull Valley, but present reports indicate that all of these 
cases are now dead and no cases of the disease exist in that locality at this time. 



LEPEOSY IN THE UNITED STATES. 



39 



Table No. 2. 



-List of States, arranged alphabetically, shoiving the presence or absence of 
leprosy in each county — Continued. 



VERMONT. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Addison 


None. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 


Lamoille 


No report. 
None. 


Bennington 


Orange 


Caledonia 


Orleans 

Rutland 


Do. 


Chittenden 


Do. 


Essex 


Washington 


Do. 


Franklin 


Windham 


Do. 


Grand Isle 


Windsor 


Do. 









Vebmont.— Fourteen counties, 
received from Lamoille County. 



Thirteen counties report no cases of leprosy therein. No report 



VIRGINIA. 



County. 



Accomac 

Albemarle 

Alexandria 

Alleghany 

Amelia 

Amherst 

Appomattox 

Augusta 

Bath 

Bedford 

Bland 

Botetourt 

Brunswick 

Buchanan 

Buckingham 

Campbell 

Caroline 

Carroll 

Charles City 

Charlotte 

Chesterfield 

Clarke 

Craig 

Culpeper 

Cumberland 

Dickenson 

Dinwiddie 

Elizabeth City . . 

Essex 

Fairfax 

Fauquier 

Floyd 

Fluvanna 

Franklin 

Frederick 

Giles 

Gloucester 

Goochland 

Grayson „ 

Greene 

Greenesville 

Halifax 

Hanover 

Henrico.... 

Henry 

Highland 

Isle of Wight 

James City 

King and Queen 
King George 



Cases of leprosy 
reported. 



None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 
No report. 

Do. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 



County. 



King William . . . 

Lancaster 

Lee 

Loudoun 

Louisa 

Lunenburg 

Madison 

Mathews 

Mecklenburg 

Middlesex 

Montgomery 

Nansemond* 

Nelson 

New Kent 

Norfolk 

Northampton 

Northumberland 

Nottoway 

Orange 

Page 

Patrick 

Pittsylvania 

Powhatan 

Prince Edward . . 
Prince George . . . 
Princess Anne . . . 
Prince William... 

Pulaski 

Rappahannock . . 

Richmond 

Roanoke 

Rockbridge 

Rockingham 

Russell 

Scott 

Shenandoah 

Smyth 

Southampton 

Spottsylvania 

Stafford 

Surry 

Sussex 

Tazewell 

Warren 

Warwick 

Washington 

Westmoreland .. 

Wise 

Wythe 

York 



Cases of leprosy 
reported. 



None. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do, 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 



Vieginia. — One hundred counties. Ninety-three counties report no cases of leprosy therein. No 
report was received from the following seven counties: Charlotte, Essex, Goochland, Halifax, Han- 
over, Madison, and Roanoke. 



40 



LEPROSY IN THE UNITED STATES. 



Table No. 2. — List of States, arranged alphabetically, showing the presence or absence of 

leprosy in each county — Continued. 



WASHINGTON. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Adams 


No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 


Lincoln 


None. 


Asotin 


Mason 


Do. 


Chehalis 


Okanogan ^ 


Do. 


Clallam 


Pacific 


Do. 


Clarke 


Pierce 


Do. 


Columbia 


San Juan 


Do. 


Cowlitz 


Skagit 


Do. 


Douglas 


Skamania 


Do. 


Ferry 


Snohomish 


Do. 


Franklin 


Spokane 


Do. 


Garfield. 




Do. 


Island 


Thurston 


Do. 


Jefferson 


Wahkiakum 


No report. 
Do. 


King 


Wallawalla 


Kitsap 


Whatcom 


Do. 


Kittitas 


Whitman 


None. 


Klickitat 


Yakima 


No report. 


Lewis 









Washington. — Thirty-five counties. Thirty counties report no cases of leprosy therein. No report 
was received from the following five counties: Adams, Wahkiakum, Wallawalla, Whatcom, and 
Yakima. 

WEST VIRGINIA. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Barbour 


None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 
No report. 
None. 
No report. 
None. 

Do. 

Do. 


Mineral 


No report. 
Do. 


Berkeley 


Mingo 


Boone 


Monongalia 


None. 


Braxton 


Monroe 


Do. 


Brooke 


Morgan 


Do. 


Cabell 


Nicholas 


Do. 


Calhoun 


Ohio 


Do. 


Clay 


Pendleton 


Do. 


Doddridge 


Pleasants 


Do. 


Fayette 


Pocahontas 


Do. 


Gilmer 


Preston 


Do. 


Grant 


Putnam 


Do. 


Greenbrier 


Raleigh 


Do. 


Hampshire 


Randolph 


Do. 


Hancock 


Ritchie 


No report. 
None. 


Hardy 


Roane 


Harrison 


Summers 


Do. 


Jackson 


Taylor 


No report. 


Jefferson 


Tucker 


None. 


Kanawha 


Tyler 


Do. 


Lewis 


Upshur 


Do. 


Lincoln 


Wavne 


No report. 


Logan 


Webster 


None. 


McDowell 


Wetzel 


Do. 


Marion 


Wirt 


Do. 


Marshall 


Wood 


Do. 


Mason 


Wyoming 


Do. 


Mercer 











West Virginia — Fifty-five counties. Forty-seven counties report no cases of leprosy therein. The 
following eight counties have not reported: 'Jefferson, Logan, Marion, Mineral, Mingo, Ritchie, Tay- 
lor, and Wayne. 



LEPEOSY IN THE UNITED STATES. 



41 



Table No. 2. 



-Lists of States, arranged alphabetically, showing the presence or absence of 
leprosy in each county — Continued. 



WISCONSIN. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Adams 


None. 

Do. 
1 case. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 
1 case. 
None. 

Do. 

Do. 

Do. 
No report. 
None. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 


Manitowoc 


None. 


Ashland 


Marathon 


Do. 


Barron 


Marinette 


Do. 


Bavfield 


Marquette 


Do. 


Brown . 


Milwaukee 


Do. 


Buffalo 


Monroe 


Do. 


Burnett 


Oconto 


Do. 


Calumet i .• 


Oneida 


Do. 


Chippewa 


Outagamie 


Do. 


Clark 


Ozaukee 


Do. 


Columbia 


Pepin 


Do. 


Crawford . 


Pierce 


Do. 


Dane 


Polk 


Do. 


Dodge 


Portage 


Do. 


Door 


Price 


Do. 


Douglas 


Racine 


Do. 


Dunn 


Richland 


Do. 


Eau Claire 


Rock 


Do. 


Florence 


Saint Croix 


Do. 


Fond du Lac 


Sauk 


Do. 


Forest. 


Sawyer 


Do. 


Grant 


Shawano 


Do. 


Green ... 


Sheboygan 


Do. 


Green Lake 


Taylor 


Do. 


Iowa 


Trempealeau 


Do. 


Iron 


Vernon 


Do. 


Jackson 


Vilas 


Do. 


Jefferson 


Walworth 


Do. 


Juneau 


Washburn 


Do. 


Kenosha 


Washington 


Do. 


Kewaunee 


Waukesha 


Do. 


La Crosse 


Waupaca 


Do. 


Lafavette 


Waushara 


Do. 


Langdale 


Winnebago 


Do. 


Lincoln 


Wood 


Do. 









Wisconsin. — Seventy counties. Sixty-six counties report no cases of leprosy therein. One case of 
leprosy is reported in Barron County and one case in Dane County. Another case of leprosy is 
reported in YVisconsin, but not definitely located. No report was received from Clark and Eau Claire 
counties. 

WYOMING. 



County. 


Cases of leprosy 
reported. 


County. 


Cases of leprosy 
reported. 


Albanv 


None. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 


Laramie 


None. 


Bighorn 


Natrona 


Do. 


Carbon 


Sheridan 


Do. 


Converse 


Sweetwater . 


Do. 


Crook 


Uinta. 


Do. 


Fremont 


Weston 


Do. 


Johnson 











Wyoming.— Thirteen counties. Reports indicate that no cases of leprosy exist in Wyoming, all the 
counties having reported no cases therein. 



42 



LEPEOSY IN THE UNITED STATES. 



Table No. 3. — Summary. 



State. 


OS 

CD 

so 
O 

o 

f-l 

CD 
A 

a 


CD 


TO 

CD 

CD 


a 

f-H 

o 
A 

cS 
o 

CD 

< 


a 

o 

A 

a 

# bp 

'CD 
O 


a 

CD 

+J . . 
O t» 
0* CD 

*-( +-> 
+2 OS 

a -^ 

CD CD 
IE +3 
cS-2 
CD B 

.22 >5 
P 


+55 

B . 

5 02 

_: © 
*-£ 

CD CO 
+J -^ 
OCO 
cS ,_ 

+J CD 

o 3 
cdP 

CD^3 

.S'53 

P 


CD 

+3 

O . 
w 
I— l 


CD 

be 
03 

+j 
«1 


6 
+j 

CD 

A 
+j 

02 

CD 

a 
< 


O 

CD 

B 


•6 

CD 

X 


6 

2 

a, 
o 

H 


be 
B 


Alabama 


1 

24 

24 

1 

5 

1 

155 

1 

2 

20 

5 

5 

1 

1 

7 

16 

1 

1 

1 

3 

3 


i 

19 
17 

5 

84 

2 
18 
3 
3 
1 
1 
7 
10 
1 

1 

2 
1 


5 

7 
1 

1 

71 

1 

2 
2 
2 


i 

5 
5 
] 
1 

119 
1 
1 

5 
3 


19 

18 

4 

1 

24 

1 

20 

2 
1 
1 
6 
16 
1 

1 
2 
3 


1 

11 

19 

1 

1 

140 
1 

5 
2 

1 
2 

1 

1 






1 

7 

24 

1 

5 

1 

117 

1 

1 

14 

3 

4 

1 

1 

7 

12 










California 


11 


17 


6 

23 
1 

56 


17 


i 






Florida 






Georgia 














Illinois 


4 
1 
1 


*38" 


2 

1 
33 


i 






Iowa 






Louisiana 


48 
1 


9 


1 


Maryland 




Massachusetts 


1 

20 

2 
1 


1 
6 
2 
1 


8 
2 
2 
1 
1 
4 
2 


2 

10 

3 

3 






Minnesota 


1 






Mississippi 






Missouri '. ; 








Montana 








Nevada 














New York 


6 


1 


4 

16 

1 

1 
2 
3 


"4" 


1 

11 
1 


1 






North Dakota 






Oregon 








Pennsylvania 


1 


1 


i 
i 
i 






1 






South Dakota 






1 
1 
2 






Texas 


1 
2 


1 


2 
3 


1 


2 






Wisconsin 














Total 


278 


176 


102 


145 


120 


186 


68 


72 


205 


107 


88 


56 


9 


1 







Table No. 4. — Nationalities represented in cases of leprosy reported. 



American 145 

Norwegian 22 

Chinese 20 

German 12 

Bahamian 12 

Icelander 11 

Swede 8 

Irish 6 

Cuban 6 

West Indian 4 

English 3 

French 3 



Mexican 3 

Italian 3 

Kanaka 1 

Greek 1 

Australian 1 

Spanish 1 

Japanese 1 

Sicilian 1 

Tahitian . . . , 1 

Unknow T n 13 



Total 278 



RECAPITULATION. 

Number of States in which leprosy exists 21 

Number of cases leprosy reported 278 

Number of males 176 

Number of females 102 

Number born in United States 145 

Number foreign born 120 

Number birthplace unknown 13 

Number who probably contracted disease in United States 186 

Number who probably contracted disease outside United States 68 

Number place of contracting disease unknown 24 

Number of cases isolated 72 

Number of cases at large 205 

Number of cases in doubt as to isolation 1 

Number of cases of — 

Anesthetic leprosy 107 

Tubercular leprosy 88 

Mixed leprosy 56 

Trophic leprosy 9 

Mutilating leprosy 1 

Doubtful diagnosis as to type 15 



LEPKOSY IN THE UNITED STATES. 43 



REPORT OF THE SECRETARIES OF THE INTERNATIONAL 
LEPROSY CONFERENCE, BERLIN, 1897. 

At the close of the debates of the International Leprosy Confer- 
ence, Berlin, 1897, the secretaries have the honor to present the follow- 
ing report of the general conclusions of the conference: 

They believe that such a resume will be especially desirable for 
those members who have been delegated by their respective govern- 
ments, and who have to make reports on the results of the conference. 

As might be expected, a considerable portion of the discussion has 
related to the bacillus Leprae, which the conference accepts as the virus 
of leprosy, and which for upward of twenty-five years has been 
known to the scientific world through the important discovery of 
Hansen and the able investigations of Neisser. 

The conditions under which the bacillus grows and develops are 
still unknown, as well as the way of its invasion into the human 
system, but from the discussions of the conference, it seems probable 
that a unanimity of opinion will soon prevail in reference to its 
modes of subsequent dissemination within the human body. 

Very interesting observations have been brought forward in con- 
nection with the elimination of the bacilli in large quantities by means 
of the skin and the nasal and buccal mucous membrances of lepers; 
it is desired that such observations be confirmed where opportunities 
occur. 

The question is of great importance to those who are intrusted with 
the care of the public health, as lepros} 7 is now acknowledged to be a 
contagious disease. 

Every leper is a danger to his surroundings, the danger varying 
with the nature and extent of his relations therewith, and also with 
the sanitary conditions under which he lives. 

Although among the lower classes every leper is especially dangerous 
to. his family and fellow- workers, cases of leprosy frequently appear 
in the higher social circles. 

The theory of heredity of leprosy is now further shown to have lost 
ground in comparison with the at present generally accepted theory of 
its contagiousness. 

The treatment of leprosy has only had palliative results up to the 
present time. 

Serum therapy has so far been unsuccessful. 

In view of the virtual incurability of leprosy and the serious and 
detrimental effects which its existence in a community causes, and 
considering the good results which have followed the adoption of legal 
measures of isolation in Norway, the Leprosy Conference, as a logical 



44 LEPROSY IN THE UNITED STATES. 

issue of the theory that the disease is contagious, has adopted the 
following resolution proposed by Dr. Hansen and amended by Dr. 
Besnier: 

1. In such countries where leprosy forms foci or has a great exten- 
sion we have in isolation the best means of preventing the spread of 
the disease. 

2. The system of obligatory notification of observation and isola- 
tion as carried out in Norway is recommended to all nations with local 
self-government and a sufficient number of physicians. 

3. It should be left to the legal authorities, after consultation with 
the medical authorities, to take such measures as are applicable to the 
special social conditions of the districts. 

Phin. S. Abraham, London, 

A. von Gergmann, Riga, 

J. J. Kinyoun, Washington, 

Edv. Ehlers, Copenhagen, General Secretary, 

Ed. Arning, Hamburg, 

E. Dubois-Havenith, Bruxelles, 

G. Thjbierge, Paris, 

Secretaries of the Conference. 






SUGGESTIONS AS TO LEPROSARIA. 

By H. M. Bracken, M. D., 

Secretary State Board of Health, St. Paul, Minn. 

It would seem to me that there should be two or more national 
leprosaria. One for the accommodation of tropical or semitropical 
people; another for the accommodation of more northern people, such 
as Icelanders and Scandinavians. It would be unreasonable to take 
the people of northern climates into a prolonged or continuous hot 
climate; on the other hand, it would be unreasonable to take those 
accustomed to a tropical climate to the cold, rigorous temperature of 
the Northern, dry States, such as Minnesota or the Dakotas. 

In my opinion a dry climate is most conducive to the suppression of 
leprosy, as demonstrated by the experience in Minnesota. It might be 
well to say, as bearing that out, that in no instance has there been 
found an American-born leper in Minnesota, and those that have come 
in are gradually dying out; on the other hand, Louisiana has a large 
number of native-born lepers, as stated in Dr. Dyer's article. 



LEPROSY IN THE UNITED STATES. 45 

[Reprinted from the Philadelphia Medical Journal. December 17,1898.] 

LEPROSY IN MINNESOTA. 

By H. M. Bracken, M. D., 

Of Minneapolis, Minn. 

In Allbutt's System of Medicine (Vol. Ill, p. 46), referring to the 
Norwegian lepers of Minnesota, Wisconsin, and Dakota, it is stated 
that these have diminished from 160 known cases to about a dozen. 
This statement is undoubtedly taken from the report of Dr. G. A. 
Hansen, of Bergen, Norway (1888), who says: 

Of about 160 lepers who have immigrated into three States (Wisconsin, Iowa, 
Minnesota) 13 are alive, whom I have seen myself, and, perhaps, 3 or 4 more. All 
the others are dead. 

This statement refers to the known lepers that left Norway and set- 
tled in the Northwestern States. In another place Dr. Hansen says: 

The number of immigrated lepers from Norway is much greater than I had any 
idea of from the knowledge I could gather at home. My friends, Dr. Hoegh and 
Dr. Gronvold, have given me the names of many lepers here in America whom we 
did not know to be lepers when they left Norway. 

The figures quoted from Allbutt's System refer, therefore, to those 
only who were known to be leprous when they left Norway, and are 
hence misleading as well as incorrect. In 1886 the Minnesota State 
board of health first reported upon the lepers of the State. An attempt 
has been made since that date, and I think with fair success, to keep 
a record of all the lepers in the State. 

The table herewith given will serve as an interesting text. 

We have knowledge of 51 lepers having resided in Minnesota. Of 
these, 17 had died before 1890. Of the 34 added to the records since 
1890, 18 were first reported upon in 1891. 2 in 1892, 3 in 1893, 2 in 
1894, 2 in 1897. and 7 in 1898 up to September 15. Little is known 
of the nationality of the 17 that died before 1890, but from various 
reports it is safe to assume they were all from Norway. Of the later 
34, 29 were probably from Norway and 5 from Sweden. Of the 5 
from Sweden, 1 was reported' first in 1894; the other 4 in 1898. 

Of those who might have belonged to the 160 known lepers that 
immigrated from Norway previously to 1888, this list can not include 
more than IT. There is a possible total of 29 cases in which the disease 
first appeared in the old country, but it is not at all probable that more 
than 22 of these were included in Dr. Hansen's list of 160. 

Undoubtedly, some of those who have reported the disease as first 
appearing after they had landed in this country have not told the 
truth. It would be fair, probably, to say that 25 of the 51 Minnesota 
lepers had the disease before leaving Europe. 



46 LEPEOSY IN THE UNITED STATES. 

Twenty-one is probably the highest number of lepers known to 
have been living in Minnesota in any one year (1893). At present 13 
are known to be living in the State. There may possibly be 3 more 
living, from whom we can secure no reports at present, and, in addi- 
tion, a few unrecorded cases. 

Of these 51 known cases, but 9 were in females. Of the latest rec- 
ord (34 cases) 21 are known to have been married (15 men and 6 women), 
and 20 of these married lepers had children. It is quite possible that 
the other one (a woman) had childen also. These 21 married lepers had 
from 1 to 8 children each. We have knowledge of at least 78 children 
born to these lepers. It is not known how many children were born 
after the parents were recognized as leprous, but it is safe to say a large 
proportion of the 78. Not one of these 78 children has become leprous, 
and in no case has the leper transmitted the disease to the companion 
in wedlock. Twenty of the 51 lepers are said to have the anesthetic 
form of the disease, 23 the tubercular, while for 8 the type of dis- 
ease is not given. 

Of the 13 lepers known to be living, I can give an outline of the 
present condition of but 6, as follows: 

JVb. 43. — Mrs. D. was born in Nysaaken Varmlandslau, Sweden. 
There is no history of leprosy in her family. Her husband, a Nor- 
wegian, states that the newspapers have reported a case, or cases, of 
leprosy near her home in Sweden since she left there. She landed in 
America (Philadelphia) in 1887, and was married in the fall of the 
same year at Warren, Minn. The first symptoms of leprosy appeared 
soon after the birth of her second child, in 1891. There was then 
swelling of the hands, feet, and face. On March 24, 1898, inspection 
showed the following conditions: The hands and feet were blue, nod- 
ular and swollen, the face u leonine," the hair falling out rapidly, the 
eyebrows gone. There was sore throat, and anesthetic spots were 
present on the extremities and the face. There were sores on her legs 
and arms from blows and burns, due to the anesthetic condition of 
those parts. She had 4 children; 2 born before the first symptoms 
of leprosy and 2 since. These were all healthy, and were aged 
respectively 9, 6, 4, and 2 years. The patient was careful and cleanly 
in her habits. She burned all bandages used, and had her own special 
towels, bedding, etc. She slept alone. The disease seemed to be 
rapidly progressing. 

Wo. 4S. — Mr. B., 55 years old, was born in Romsdal, Norway. He 
gives no history of leprosy in his family, but states that there were 
lepers near his native home. He landed in America (New York) in 
1872. The first symptoms of leprosy^ appeared in 1874. These were 
anesthesia in both hands, preceded by severe pains. The ears are 
slightly nodular. The disease is not progressing rapidly. There is 



LEPROSY IN T THE UNITED STATES. 47 

mutilation of the fingers. The patient is not married. His habits 
are good. 

No. 1^6. Mr. E., 37 years old, was born in Vermland, Sweden. 
When 20 } T ears of age (1861) he worked on a log-drive in Sweden with 
Norwegians. There is no history of leprosy in his family. He came 
to America in 1884, married in 1885, and has 2 children, aged respect- 
ively 11 and 8 }~ears, both in good health. In 1892 nodules first 
appeared on the forehead and back. In 1893 the face became involved. 
The disease is progressing, but the patient is still able to follow his 
occupation as a tailor. He is careful in his habits. 

No. Ifl. Mr. L., 10 years old, was born in Helsingland, Sweden. 
He knows of no leprous relations. He landed in America (Boston) in 
1881. About 1888 anesthesia appeared in the feet. The patient is 
married, and has 5 children (girls), ranging from 16 to 8 years of age, 
all healthy. 

No. Jfl. Mrs. P., 53 years old, was born in Vermland, Sweden, 25 
miles from Stockholm. She knows of no leprous relatives or neigh- 
bors. About twenty-five years ago she landed in America (Montreal). 
About twelve years ago she first noticed severe pains in the lower 
limbs. At present (1898) her hands, feet, and face show marked evi- 
dence of the disease. She has had 6 children, 4 of whom are dead. 
The two living are aged about 16 and 12, both girls, and are healthy 
and rugged looking. The patient is not cleanly in her habits, and if 
the family escapes infection it will not be due to any precautions 
taken by her. Her husband # ears the disease, and this fear may lead 
him and his children to protect themselves so far as possible. 

No. 51. — Mr. J., 55 years old, was born in Norway. He has a 
brother in the leper hospital in Bergen, Norway. He came to Amer- 
ica about twenty years ago and first noticed symptoms of the disease 
about seven years ago. He is married and has 8 children, all healthy. 

The history of these six cases gives some idea of the type of leprosy 
found in Minnesota. It is undoubtedly possible to find such cases 
wherever people from the Scandinavian Peninsula have settled in the 
States or Canada. It is difficult to secure a clear histoiy of the course 
of the disease. 

Let me draw attention to a few facts emphasized by this table and 
these records: 

(1) The impression that leprous immigrants from the Scandinavian 
Peninsula are all from Norwa} T is a wrong one. Five of 11 lepers 
placed on file by our board during 1897 and 1898 are from Sweden. 

(2) The feeling that we can quarantine against lepers by watching 
immigrants is an unsafe one. The family history of all immigrants 
from a countiy where leprosy prevails should be secured before they 
are allowed to embark for America, and no member of a leprous fam- 
ily should be permitted to land upon our shores. 



48 LEPEOSY IN THE UNITED STATES 

(3) It would appear that the conditions antagonistic to the spread of 
leprosy in Minnesota are also opposed to sterility, as borne out by the 
families of several of our lepers. (Some of these have children, as 
shown by the following figures: 5, 5, 6, 6, 4, 6, 4, 5, 8.) 

(4) It is quite possible for leprosy to die out in certain favored sec- 
tions of the country, such as Minnesota, without segregation, provided 
the importation of lepers be discontinued. 

(5) Even in Minnesota, one has but to visit some of these lepers to 
feel that segregation should be insisted upon in all cases. One can not 
but feel on entering a filthy home and seeing a leprous mother care- 
less in her habits that the children are not safe. 

(6) Segregation in single States is not practical. It would tend 
simpty to drive lepers from States enforcing such practice to those 
that were not carrying out the system. • 

(7) A Federal home should be provided for these unfortunates. 
They could thus be cared for more economically and more satisfactorily 
than through any State provision. 

(8) In spite of all precautions that we may take, there will be some 
leprous individuals in this part of the world for many years to come. 

(9) The Scandinavian Peninsula does not furnish all leprous individ- 
uals found in the United States. 

Finally, great care must be exercised in dealing with lepers in the 
future. That we have been constantly importing leprosy is a recog- 
nized fact. That the chances of importing it will probably be in- 
creased rather than diminished unless great care is taken in dealing 
with infected countries, no one can doubt. All the lepers that come 
to America do not settle in the Northwestern States, and all sections 
of the country may not be so fortunate in affording such poor soil for 
the spread of the disease as does Minnesota. 

It is altogether probable that there are some lepers in Minnesota 
that are not registered by the State board of health. Assuming that 
there may be a total of 20 lepers in Minnesota, it is a safe estimate, 
based on the United States census for 1890 of the Scandinavian for- 
eign-born population, that there are at least 20 lepers in the four 
States — Wisconsin, Iowa, South Dakota, and North Dakota — and 
probably 120 Scandinavian lepers in other parts of the United States, 
making a probable total of 160 Scandinavian lepers in the United 
States. Basing our estimate on what is positively known to exist in 
Minnesota, the figures for the three divisions given would be approxi- 
mately 13, 13, 78, or a total for the United States of 104 Scandinavian 
lepers. If we base our estimates on the Norwegian foreign-born 
population in the United States, we should then have for the three 
districts a total of probably 91 Norwegian lepers. 



LEPROSY IN THE UNITED STATES. 



49 



No. 



1 
2 
3 
4 
5 
6 
7 
8 
9 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 
51 



Nationality. 



Norwegian. 
Norwegian . 



Norwegian . 



Norwegian . 
Norwegian . 



Norwegian . 
Norwegian . 
Norwegian . 
Norwegian . 
Norwegian . 



Swede. 



Swede 

Norwegian . 
Norwegian . 



Swede 

Norwegian , 

Swede 

Norwegian . 
Norwegian . 



Disease appeared 

after coming to 

America. 



( a ) 

10 years. 
1 year... 
10 years. 
3 years . . 

( a ) 

( a ) 

9 years.. 

do.. 

5 years . . 
7 years.. 



( a ) 

( a ) 

7 years. 



( a ) 

a ) 

( a ) 

( a ) 

20 years 

9 vears 

(*)...:.. 

( a ) 

( a ) 

3 years 

( a ) 

4 years 
19 years 
17 years 

( a ) 

4 years 
16 vears 

( a )* 

8 years 

( a ) 

(?) 

(?) 

7 years 
4 years 

8 years 
3 years 
8 years 
6 years 

( a ) 



( a ). 



Date of- 



Birth. Death 



1831 
1822 
1843 
1846 
1848 
1815 
1848 
1825 
1854 
1839 
1853 
( b ). 
( c ) 
( d ) 
( e ) 
1849 
1842 
1816 
1854 
1830 
1840 
1848 
1820 
1834 
1857 
1838 
1840 
1843 
1864 
1850 
1850 
1826 



1871 
1851 
1867 
1852 
1860 
1853 
1845 
1845 
1860 
1865 
1867 
1843 
1861 
1858 
1862 
1845 
1863 
1843 



1880 
1878 
1878 
1876 
1878 
1877 
1868 
1885 
1885 
1884 
1886 
1888 
1888 
1889 
1889 
1890 
1890 
1895 
1892 



1896 
1896 



1894 
189- 



1897 
1899 
189- 
1892 



189- 
189- 
189- 



1897 
1894 
1897 



1897 



1890 
*i898' 



Age. 



78 
64 



58 



34 



72 



31 
46 
38 



33 



55 

37 
40 



53 



?b 



Sex. 



M. 
M. 
M. 
M. 
M. 
M. 
M. 
M. 
F. 
M. 
M. 
M. 
M. 
M. 
M. 
M. 
M. 
M. 
M. 
M. 
M. 
M. 
M. 
M. 
M. 
M. 
F. 
M. 
M. 
M. 
F. 
M. 
F. 
F. 
M. 
M. 
M. 
M. 
M. 
F. 
M. 
M. 
F. 
M. 
M. 
M. 
M. 
F. 
F. 
M. 
M. 



Social 
state. 



Married 



Married 
Single . . 
Married 

do.. 

do.. 

Single . . 
Married 
Single . . 
Married 



Married 
Married 
Married 
Married 
Married 



Married 
Married 
Single . . 
Married 
Single . . 
Single . . 



Married 
Single . . 
Married 
Married 



Married .. 



Single . . 
Married 
Married 
Single . . 
Married 
Married 
Married 



N um- 
ber of 
chil- 
dren. 



Some. 



a Disease appeared in Europe. 
''Between 1818-1828. 
c Between 1818-1858. 



<J Between 1829-1839. 
e Between 1858-1868. 



ARE NATIONAL LEPROSARIA IN THE UNITED STATES 

DESIRABLE? 

By H. M. Bracken, M. D., 

Secretary and Executive Officer Minnesota State Board of Health. 

In order to answer this question intelligently it is necessary to make 
a careful study of leprosy. Early in the year I sent a circular letter 
to the various provincial and State sanitary authorities asking for 
information regarding leprosy within their jurisdictions, and also 
asking their opinion as to the best method of caring for lepers. The 
S. Doc. 269- — ± 



50 



LEPEOSY IN THE UNITED STATES. 



information returned is given in condensed form in the following 
table : 

TABLE. 






Name of province or 
State. 


Is there 
any rec- 
ord of lep- 
ers within 

your 
jurisdic- 
tion? 


How have they 
been cared for? 


What future system 
for the cafe of 
lepers would you 
suggest? 


Name of reporter. 


Manitoba 


Yes 




National 




New Brunswick 


...do.... 


At a national 
lazaretto. 






Nova Scotia 


...do.... 


National 


Dr. A. P. Reid. 


Ontario 


No 




do 


Dr. P. H. Bryce. 

Dr. E. Pelletier. 


Quebec 


...do 




do 


Arkansas 


...do 


No svstem 


do 


Dr. R. B. Christian. 


California 


Yes 

No 

...do 


Countv care 


.....do 


Dr. W. P. Mathews. 


Colorado 


No svstem 


do 


Dr. G. E. Tyler. 
Dr. C. A. Lindslev. 


Connecticut 


do 


National or State 

National 


Delaware 


...do.... 


do 


Dr. A. I. Lowber. 


Illinois a 


...do.... 


do 


State and national 

National 


Dr. J. A. Egan. 
Dr. J. N. Hurtv.. 


Indiana 


...do.... 


do 


Iowa 


Yes 

No 
...do 


Isolation at 

home. 
No system 


do 


Dr. J. F. Kennedv. 


Kansas 


do 


Dr. W. B. Swan. 


Kentucky 


do 


Countv care 


Dr. J. N. McCormack. 


Louisiana 


Yes 

No 
Yes 


State care 

No svstem 


National 


Dr. G. F. Patton. 


Maine 


do 


Dr. A. G. Young. 
Dr. J. S. Fulton. 


Maryland 


do 


do 


Massachusetts 


No 


do 


National or State 

No suggestion to offer. 
National 


Dr.S. W.Abbott. 


Michigan 


...do.... 


do 


Dr. H. B. Baker. 


Minnesota 


Yes 

No 

...do.... 


Isolation at 

home. 
No svstem 


Dr. H. M. Bracken. 


Mississippi 


do 


Dr. J. F. Hunter. 


Nebraska 


do 


do 


Dr. F. B. Crummer. 


New Hampshire 


...do.... 


do 


No suggestion to offer. 
do 


Dr. I. A. Watson. 


New Jersey 


Yes 

No 

Yes 


Countv care 


Dr. H. F. Mitchell. 


New Mexico 


No svstem 

do 


National 


Dr. T. P. Martin. 


New York 


Probably national 

National 


Dr. B. F. Smelzer. 


North Carolina 


No 


do 


Dr. R. H. Lewis. 


North Dakota 


Yes 

...do.... 


Countv care 


do 


Dr. H. D. Quarrv. 


Ohio 


No svstem 


do 


Dr. C. 0. Probst, 


Oklahoma 


No 


do 


do 


Dr. L. H. Buxton. 


Pennsylvania 


Yes 

No 

Yes 


Citv 


do 


Dr. Benj.Lee. 
Dr. G. T. Swartz. 


Rhode Island 


No svstem 

do 


National or State . 
No suggestion to offer. 
National 


South Carolina 


Dr. T. G. Simons. 


South Dakota 


...do... 


Countv 


Dr. A. E. Clough. 


Tennessee 


No 

Yes 

No 

...do.... 


No system 


do 


Dr. J. A. Albright. 
Dr. W. T. Blunt. 


Texas 


Sent to Louisi- 
ana. 

No system 

do....: 


State 


Vermont 


National 


Dr. J. H. Hamilton. 


Virginia 


do 


Dr. P. A. Irving. 
Dr. U. 0. B. Wingate. 


Wisconsin 


Yes 


Isolation at 
home. 


do 







Three provinces and 14 States report having had lepers to deal with. 
Other States undoubtedly belong in this list. It has been possible for 
me to make a somewhat careful study of lepros} r in the Northwest. 
This report will therefore be given in four parts. The first part will 
relate to cases of leprosy reported officially from five States, viz, 
Iowa, Wisconsin, Minnesota, North Dakota, and South Dakota. The 
second part will relate to the cases of leprosy reported officially from a 
few other States. The third part will give the history of a few cases 
of leprosy of which I have knowledge through private information. 
The fourth class includes five cases, some of whom ma} r have been 
already reported in parts 1 or 3. The possibility of duplication in 
dealing with these cases is so strong that 1 have preferred report- 
ing them as a distinct class. The location in which the official cases 



LEPKOSY IIS" THE UNITED STATES. 



51 



have, or had, residence will be given. The nonofficial cases, for evi- 
dent reasons, can not be located. 

Part I. — Lepers reported officially from Iowa, Wisconsin, Minnesota, South and North 

Dakota. 



No. 


State. 


Nationality. 


Disease 

appeared 

abroad. 


Date of 
birth. 


Date of 
death. 


Type of disease. 


1 


Iowa 


Norwegian 


Yes 

...do 


1880 


1899 


Tubercular. 


2 


do 


do 




3 


do 


do 


...do 








4 




do 


...do 








5 


do 


do 


...do 


1897 


1897 


Do. 


6 


do 


do 








.do... 


do 










8 


.do 


do 




1898 
1839 
1853 
1831 
1822 
1843 
1846 
1848 
1815 
1848 
1825 
1854 
1839 
1853 
1826 
1851 
1831 
1862 
1849 
1842 
1816 
1814 
1830 
1840 
1848 
1820 
1834 
1857 
1838 
1840 
1843 
1864 
1850 
1850 
1826 


1898 
( a ) 

(a) 

1880 
1878 
1878 
1876 
1878 
1877 
1868 
1885 
1885 
1884 
1886 
1888 
1888 
1889 
1889 
1890 
1890 
1896 
1892 
1899 
1896 
1896 

(a) 

1900 
1894 
189- 

( a ) 
1897 
1899 
189- 
1892 
1895 
189- 
189- 
189- 
( a ) 
( b ) 

(a) 

1897 
1894 
1897 
( c ) 
( a ) 
1897 

(a) 
( a ) 
( a ) 

1890 
1900 
1898 

(a) 

( a ) 
( a ) 
( a ) 
( a ) 
1899 
1898 
( a ) 
( a ) 
1895 

( c ) 
( a ) 

( a ) 
( a ) 

(a) 


Anaesthetic. 


9 


do 


do 




Do. 


10 


do .'... 


Swedish 


Yes 

...do 


Tubercular. 


11 


Minnesota 


Norwegian 


Anaesthetic. 


12 


...do 


do 


...do 


Tubercular. 


13 


...do 


do 


No 

...do 


Anaesthetic. 


14 


.do 


do 


Tubercular. 


IF. 


...do.. 


do 


...do 


Do. 


16 


...do 


do 


Yes 

...do 


Do. 


17 


...do 


do 


Anaesthetic. 


18 


do 


do 


No 

...do 


Do. 


IP 


do 


do 


Tubercular. 


9(1 


...do 


do 


...do 


Anaesthetic. 


?1 


...do 


Swedish 


...do 


Do. 


99 


...do 


Norwegian 


...do 




93 


...do 


do 




Tubercular. 


94 


do 


Swedish 


Yes 

No 

Yes 

...do 


Do. 


95 


do 


Norwegian 


Do. 


96 


do 


do 


Anaesthetic. 


°7 


do 


do 


Tubercular. 


98 


do 


do 




Do. 


9q 


do 


do 




Do. 


30 


do 


do 


Yes 

...do 


Anaesthetic. 


31 


do 


do 


Do. 


3? 


do 


....do.. 


...do .. 


Do. 


33 


do 


do 


...do 


Do. 


34 


do 


do 


Tubercular. 


35 


do 


do 




Do. 


36 


do 


do 


Yes 

...do 


Do. 


37 


do 


do 


Anaesthetic. 


38 


do 


do 


...do 


Do. 


39 


do 


do 


Tubercular. 


40 


do 


do 


Yes 


Mixed. 


41 


do 


do 


Tubercular. 


4? 


do 


do 




Anaesthetic. 


43 


do 


do.. 




Do. 


44 


do 


do.. 


Yes 


1871 
1851 
1867 
1852 
1860 
1853 
1845 
1845 
1860 
1865 
1867 
1843 
1861 
1858 
1862 
1845 
1863 
1843 
1856 
1856 
1845 


Tubercular. 


45 


do 


do 


Do. 


46 


do 


do 




Do. 


47 


do 


do 


Yes 


Do. 


48 


do 


do 


Anaesthetic. 


49 


do 


do 


Yes 

do 


Tubercular. 


50 


do 


Swedish 


Do. 


51 


do 


do 


do 


Do. 


ft? 


do 


Norwegian 




Mixed. 


53 


do 


Swedish 




Tubercular. 


54 


do 


Norwegian 




Anaesthetic. 


55 


do 


do 




Mixed. 


56 


do 


Swedish 




Tubercular. 


57 


do 


do 




Mixed. 


58 


do 


Norwegian 


Yes 


Anaesthetic. 


59 


do 


Swedish 


Mixed. 


60 


do 


Norwegian 


Yes 


Tubercular. 


61 


do... 


do 


Do. 


fi? 


do 


do 


No 

do.... 


Mixed. 


63 


, do 


Swedish 


Do. 


64 


i do 


Norwegian 


do 


Tubercular. 


65 


| do 


do 


Yes 


Mixed. 


6fi 


i do 


do 


do 


1828 
1856 


Anaesthetic. 


67 


1 do 


do 


do 


Tubercular. 


68 


do 


do 




Do. 


69 


do 


do 


Yes 

No 


1869 


Do. 


70 


.....do 


do 


Do. 


71 


do 


do 


Yes 




Anaesthetic. 


7?, 


South Dakota 


do 




1878 
1847 
1870 
1886 


Tubercular. 


73 


North Dakota 


do 




Do. 


74 


do 


Swedish 




Do. 


74 


do 


Norwegian 




Not leprosy. 











a Living. 



t> Dead. 



«Gone. 



52 



LEPKOSY IN THE UNITED STATES. 



Part II. — Lepers reported officially from other States than above. 



No. 


State. 


Nationality. 


Disease 
appeared 
abroad. 


Date of 
birth. 


Date of 
death. 


Type of disease. 


75 


Pennsylvania 


Maryland 






1900 

(a) 

1900 
1900 
1897 
( b ) 

( b ) 


Tubercular 


7fi 


do 


Pennsylvania 




1822 
1850 
1856 


Mixed. 


77 


do 

do 


Swedish 




Tubercular. 


7R 


Pennsylvania 




Do. 


79 


do 


Chinese 






80 


do 


do 






Do. 


81 


New Jersey 


do 








8? 


Ohio 


(?) 





















a Living. 

Part III. 



*Dead. 
Unofficial list of lepers. 



Num- 
ber. 


Nationality. 


Num- 
ber. 


Nationality. 


Num- 
ber. 


Nationality. 


1 

2 
3 


Mexican. 

American. 

Chinese. 


4 

5-9 

10-21 


Greek. 

Norwegian. 

Icelandic. 


22 
23-25 


Chinese. 
Norwegian. 



Part IV. — Possible duplicates. 



Num- 
ber. 


Nationality. 


Num- 
ber. 


Nationality. 


Num- 
ber. 


Nationality. 


A-B 


Norwegian. 


C-D 


Icelandic. (?) 


E 


Chinese. 



SUMMARY OF CASES REPORTED. 

Official '. 82 

Nonofficial 25 

Possible duplicates 5 

Total 112 



OFFICIAL LIST OF LEPERS. 

Case 1. — This patient's mother was recognized as leprous two years 
before she gave birth to this child, and was placed in a leprosarium in 
Norway, where she died four years after her disease was recognized. 
The father married again (whether in Norway or the United States is 
not stated), and settled on a farm in Iowa. Tubercular leprosy 
appeared in this child when 6 years old, and she died at the age of 18. 
She lived at home, and, although quite strictly isolated, was probably 
better cared for and happier than she could possibly have been in a 
leprosarium. She slept and ate by, herself, but was not excluded 
entirely from association with other members of the family. 

Neither an older sister (born before the mother showed evidences of 
the disease) nor stepsisters have leprosy. 

Cases #, 3 and J+. — I have so far been unable to obtain a full record 
of these cases. 

Case 5. This man, a Norwegian, died in 1897. He was married, and 
his widow and children (four) are living and healthy. He came to 
America about 18&t and showed slight symptoms of tubercular lep- 



LEPKOSY IN THE UNITED STATES. 53 

rosy at that time. His general condition toward the end was bad. 
He was a county charge, and there was more or less complaint in the 
community concerning the methods of quarantine pursued. His life 
was not made more tolerable b} T such unnecessary complaints. 

Cases 6 and 7. — Of these I have no records. 

Case 8. — This man, a Norwegian, died in 1898. His age at the time 
of death is not given. His mother was recognized as leprous when 
he was 12 years old. His was of the anaesthetic t} T pe. He was poor 
and a county charge; was never married. He was a sufferer for years. 
Undoubtedly his life might have been made more tolerable had he 
been properly cared for. 

Case 9. — This man, a Norwegian, still living, is about 66 years old. 
He is married and has several grown children. The wife and children 
are all free from leprosy. His is the anaesthetic form of the disease, 
and has been present for about twenty -five years. His hands and one 
foot are deformed. One leg has been amputated, and the sight of one 
eye is lost. Financially he is comfortably well off, and is cared for by 
his wife and married daughter. 

Case 10. — A Swedish woman, still living, aged 42 years. She is 
said to be single, and to have the tubercular form of the disease, which 
is now in the advanced state. She is said to have had leprosy since 
birth. She is cared for at her home, in a secluded manner, and is 
comfortable. 

Case 11. — A male (Norwegian), died at the age of 49, in 1880. His 
was the anaesthetic form of leprosy, from which he is said to have 
suffered for a period of twenty-four years. He was resident in the 
United States nineteen years. The financial condition or general 
surroundings of this patient are not known. One maternal great-uncle 
was leprous. 

Case 12. — A male (Norwegian), died at the age of 56, in the year 
1878. He is said to have had the tubercular type of leprosy, and is 
also said to have been ill fourteen years, the disease appearing, accord- 
ing to the records, ten years after his arrival in this country. Nothing 
is known of this man's financial condition or the system pursued in car- 
ing for him. He had a leprous cousin, but no other leprous relatives 
are noted. 

Case 13. — A male (Norwegian), died at the age of 35, in 1878. He had 
the anaesthetic type of the disease for a period of ten years, nine of 
which were said to have been spent in this country. Nothing is 
known of the financial condition or care given this patient. A pater- 
nal uncle was recognized as leprous. 

Cases H, 15, and 29. — These may well be considered together. 
They were three brothers, born in Norway. The father died of 
leprosy. In 1864 an elder brother sent for his widowed mother and 
her other children (three sons and one daughter) to come to Minnesota. 
These three sons all died of tubercular leprosy, one in 1876 (case 14), 



54 LEPEOSY IN THE UNITED STATES. 

the second in 1878 (case 15), and the third in 1892 (case 29). The first 
two were married, but left no children. Both widows married, and 
are still living and well. The third case was never married. The first 
two were probably as well cared for at their homes, on a farm, as they 
could possibly have been at a leprosarium. The third lived in a small 
city. He had been in business, and was a general favorite. When 
the disease became well marked and revolting he was tolerated as a 
stranger would not have been. The mother, the oldest brother, and 
the sister (younger than cases 14 and 15) escaped infection. The 
mother died at the age of 87. The brother and sister are still living. 

Case 16. — This man, a Norwegian, died at the age of 62, in 1877. 
His disease was recognized as of the mixed type. It had existed for a 
period of thirty years, the last twenty-one of which were passed in 
this country. Nothing is known of the surroundings or care of this 
patient. His brother and a paternal uncle were recognized as lepers, 
living presumably in Norwa}^. 

Case 17. — This man, a Norwegian, died at the age of 30, in 1878. 
His disease was of the anaesthetic type. Its duration is not given; 
neither have we any knowledge of the care he received or of his sur- 
roundings. A maternal uncle is said to have been leprous. 

Case 18. — This man, a Norwegian, died at the age of 60, in 1885. 
He was one of the lepers seen by Prof. William Boeck, of Christiania, 
when here in 1869-70. His was the anaesthetic form of the disease, 
and it had existed for a period of at least twenty years. He was resi- 
dent in the United States twenty-nine years. There is no further 
record of this case, except that he belonged to a decidedly leprous 
family in Norway, his father, a paternal aunt, brothers, sisters and 
cousins being recognized as leprous. 

Case 19.— This patient, a woman, died at the age of 31, in 1885. Her 
nationality is not given, but she was presumably a Norwegian. The 
disease was of the tubercular form, and is noted as having been 
present for nine years, and having made itself manifest nine } T ears 
after she came to America. She was in the United States eighteen 
years. Nothing more in the history of this case is given. 

Case 20. — This man died at the age of 41, in 1885. His nationality 
is not given, but he was presumably a Norwegian. His was the anaes- 
thetic form of leprosy, and the records state that it was recognized 
eleven years before his death. He was resident in the United States 
sixteen years. Nothing more is known of this case. 

Case 21. — This man, from Sweden, died at the age of 34 years, in 
1886. His was the anaesthetic form of the disease, and its duration is 
said to have been about ten years. He became a county charge. He 
was not married. 

Case 22. — Of this man there is no record further than that he was 
a Norwegian, that he died at the age of 62, in 1888, and that he was 
married. His home had been in the country. 



LEPROSY IN THE UNITED STATES. 55 

Case 23. — This man, a Norwegian, died at the age of 37, in 1888. 
His was the tubercular form of leprosy. The duration of the disease 
is not known. He was poor and had some financial aid from the city 
in which he lived, but he remained at home and was well cared for by 
his wife. The attending physician informs me that the patient had 
two children, aged, respectively, about 14 and 15 } 7 ears, both bright, 
and in attendance at the public schools. His home was a sample of 
neatness. Neither his wife nor children showed any evidence of the 
disease. 

Case 2^. — This man, a Swede, died at the age of 58 years, in 1889. 
His was probably the tubercular form of the disease, although it is 
not so stated by the reporter. He was married, and of his eight 
children seven are still living, ranging from 20 to 40 years of age. 
The widow is also still living. None of these show any signs of 
leprosy. He was cared for at home. No facts are available as to his 
financial condition or general surroundings during his lon'g illness. It 
is said that the disease was recognized soon after his arrival in this 
country, in 1881. 

Case 25. — This man, a Norwegian, died at the age of 27, in 1889. 
His was the tubercular form of the disease. It is not known how 
long the disease existed. The man was single and of the ne'er-do-well 
type. When he became helpless he became a county charge and 
died in a "pesthouse," where the care given him was not that of a 
modern hospital. 

Case 26. — This man, a Norwegian, died at the age of 51 years, in 
1890. His was the anaesthetic form of the disease. The disease is 
said to have been present for twelve years. There is no record of 
this man or his surroundings further than that he was married. His 
death certificate was signed by a coroner, so I presume a properly 
equipped and conducted leprosarium might have been an improve- 
ment upon the place in which he spent his last days. 

Case 27. — Of this man there is no record further than that he was 
a Norwegian, and died at the age of 48, in 1890. His was the tuber- 
cular form of the disease, said to have been in existence thirty j T ears, 
and to have appeared twelve years before he came to America. 

Case 28. — This man, a Norwegian, died at the age of 79 years in 
1895. His was the tubercular form of the disease. It was recognized 
first twenty-two years before his death, and seven years after his 
landing in America. He had a comfortable home and was well cared 
for. Five children are living, none of whom show any signs of the 
disease. 

Case 30. — This man, a Norwegian, died at the age of 69 in 1899. 
His was the anaesthetic form of the disease. He came to America in 
1874, and had been recognized as leprous since 1860. He is said to 
have been self-supporting. I have no knowledge of his surroundings 
or general care. 



56 LEPROSY IN THE UNITED STATES. 

Case 31. — This man, a Norwegian, died at the age of 56 years in 
1896. His was the mixed form. The disease is said to have first 
appeared in 1858. He came to America in 1871. He was a single 
man, and lived alone in a hut not far from his brother. He is described 
as having been "hideous" to look upon. Both lips, the nose, and all 
of the fingers were gone. Both lower eyelids were everted. Tubercles 
were present in various parts of the body. The latter days of this 
patient must have been of a character hard to realize. Truly a lepro- 
sarium would have been a blessing to him. 

Other members of this man's family showed no evidences of the 
disease. 

Case 32. — This man, a Norwegian, died at the age of 48 in 1896. 
His was the anaesthetic form of the disease. There is no record of its 
duration or of the general surroundings of the patient. His father 
died a leper in this country (case A, page 22), as did also one brother 
(case 70). He left a widow and 5 children, none of whom have ever 
shown evidence of the disease. 

Case 33. — This man, a Norwegian, is still living, at the age of 80 in 
1900. His is the anaesthetic form of the disease. He has been a suf- 
ferer for many years and is most emphatically a case for a well-cared- 
for leprosarium. 

Case 31±. — This man, a Norwegian, died at the age of Q6 years early 
in 1900. His was the tubercular form of the disease and had been 
known to exist for sixteen years. He was a farmer, in comfortable 
circumstances, and was well cared for by his wife and one son, who 
lived at home when I visited him in 1899. His room was neat and 
well kept. He was as comfortable as possible for one confined to bed 
with tubercular leprosy to be. The disease was loathsome to look 
upon. At present his widow and 6 children, all grown, are living. 
None of these show any signs of leprosy. 

Case 35. — This man, a Norwegian, died at the age of 37 years in 
1894. His was the tubercular form of the disease, and had been pres- 
ent for at least nine years. There is no record of this man or his sur- 
roundings, but it is probable that he was living on a farm, and was 
taken care of at home. His wife and three children were reported as 
free from any evidences of this disease in 1898. 

Case 36. — This man, a Norwegian, died at the age of about 53 years. 
His was of the tubercular form. Nothing is known of the care he 
received, but probably he was well cared for at home. He was ill 
about ten years. His wife and two daughters were reported as in good 
health in 1898. Both daughters are school-teachers. 

Case 37. — This woman, a Norwegian, is still living at the age of 60 
years. The disease is of the anaesthetic type and is said to have been 
present since 1870. She is not careful or cleanly in her habits, and is 
a proper case for a well-regulated leprosarium. She came to Minnesota 
from Wisconsin. 



LEPEOSY IN THE UNITED STATES. 57 

Case 38. — This man, a Norwegian, died at the age of 53 in 1897. 
His was the anaesthetic form of the disease, and was known to have 
been present for twelve years before his death. I have no history of 
his surroundings. His wife and three children were reported in 1898 
as free from any evidences of leprosy. 

Case 39. — This man, a Norwegian, died at the age of 35 in 1899. 
His was the tubercular form of the disease, and it is said to have first 
appeared in 1882. Although a leper, he, a laboring man, took care of 
himself in a city until shortly before his death. 

Case Jfi, — This man, a Norwegian, died when over 50 } r ears of age 
some time after 1890. His was probably the mixed form of the 
disease, and was of long standing. He was poor and should have been 
cared for in a leprosarium. His widow married again. She and his 
child (a boy) have never shown any evidences of this disease. 

Case 4,1. — This woman, a Norwegian, died at the age of 42 in 1892. 
Hers was the tubercular form of the disease. She was married, but 
there is no record of her having had an}^ children, The disease is said 
to have been present for eighteen years. Nothing is recorded as to 
how she was cared for. 

Case 1$. — This man, probably a Norwegian, died at the age of 69 
in 1895. His was the anaesthetic type of the disease. It had been 
known to be present for at least twenty years. He was a county 
charge for man} r years, and a leprosarium would have been the proper 
place for him. He was not married. 

Case 43- — This woman, probably a Norwegian, died some time after 
1890. Hers was the anaesthetic form of the disease. Its duration is 
not known, nor do the records show how old she was at the time of 
death. She came to Minnesota from Wisconsin. She was married 
and had three or four children, all of whom were reported healthy in 
1898. Her general surroundings are not recorded. 

Case 44- — This woman, a Norwegian, was a leper when she came to 
America in 1890. After staying here two or three years she returned 
to Norwa} r , where she died. She was single. There is no record as 
to how she was cared for in this country. She is said to have been 
poor. 

Case 45- — This man, a Norwegian, was recognized as leprous about 
1886. He was then 35 years old and had been in America about four 
years. He was married and had at that time three or four children liv- 
ing. His was the tuberculous form of the disease. He was poor. 
About 1892 he was sent back to Norway, where he died later. 

Case 4^. — This man, a Norwegian, is still living. He was born in 
1867, and was known to be leprous in 1890. His is the anaesthetic 
form of the disease. He is single and poor, and should be in a 
leprosarium. 



58 LEPEOSY IN THE UNITED STATES. 

Case 4-7. — Of this man, a Norwegian, but little is known. His was 
the tubercular form of the disease. He was first reported to the Min- 
nesota State Board of Health as leprous in 1892. He had then been 
unable to work for four years. The disease is said to have appeared 
in 1884, the same year that he landed in America. This means simply 
that he came to America a leper. In all probability he is dead, for 
repeated attempts have failed to find him. There is no record as to 
his pecuniary condition. He was born in 1852. 

Case lfi. — This man, a Norwegian, is possibly living still, but it has 
been impossible to get any trace of him during the past three years. 
He was born in 1860, and was recognized as leprous in 1890. He was 
then a married man with a wife and three healthy children. He is 
said to have been in comfortable circumstances and to have had the 
disease in mild form — anaesthetic. 

Case 49. — This man, a Norwegian, died at the age of 41, in 1897. 
His was the tubercular form of the disease. It had been recognized 
as present for at least twenty-four years. He was poor and a proper 
case for a leprosarium. He was single. 

Case 50. — This woman, from Sweden, died at the age of 47, in 1894. 
She was recognized by a noted leprologist as leprous in 1893, the 
disease being of the tuberculous type. In spite of this the physician 
who attended her in her last illness (pneumonitis) stated that he did not 
think she had leprosy. This simply illustrates the ease with which 
the disease may be passed over by the ordinary practitioner. She was 
married and had six children, all of whom were in good health in 
1898. There is no record of her financial condition or the means 
employed to care for her. 

Case 51. — This man, from Sweden, died at the age of 52, in 1897. 
The disease is said to have appeared in 1892. It was of the tubercular 
type. He was comfortably fixed financially, and was well cared for at 
home. He left a widow and four or five children, all reported healthy 
in 1898. 

Case 5*2. — This man, a Norwegian, was born in 1860, and was recog- 
nized as a leper in 1889. He lived in Chicago at one time, but came 
to Minnesota for treatment b}^ a Norwegian physician familiar with 
leprosy. His was of the tubercular type. He had a hard experience 
when he first came to Minnesota. He was practically chased from one 
place to another, until finally concealed for a time. The people tried 
to send him back to Chicago, but the car in which he was traveling 
was sidetracked at La Crosse, and from here he was finally removed 
by wagon a distance of over 100 miles into a safe place and under the 
care of a kind-hearted physician. The physician who had him in charge 
died, and it is said the patient then found his way to Norway and 
entered a leprosery. Whether he is still living is not known. He has 
sufficient means to pay his way comfortably, and if he had not been 



LEPKOSY IN THE UNITED STATES, 59 

persecuted his life might have been made tolerable. His case illus- 
trates the needs of leprosaria as a refuge for unfortunates. 

Case 53. — This woman, from Sweden, was born in 1865, and is still 
alive. She came to America in 1887, and soon afterwards married a 
Norwegian. In 1889 leprosy appeared. She is an exceedingly neat 
woman, and does everything in her power to prevent any possible 
infection of her family. Hers is the tubercular form of the disease. 
She has four children, two born before the disease appeared, two 
since. All of these, as well as the husband, were free from any symp- 
toms of leprosy when seen by me in March, 1897. The oldest child 
was of age to enter the public school, but the sentiment against lep- 
rosy was so great as to exclude her, although perfectly well. The 
husband was a carpenter, and it was almost an impossibility for him 
to secure work because of his wife's disease. The poor woman was 
longing for death to come in order that the persecution of her family 
on her account might cease, but she is still suffering, not only physic- 
ally but mentalty. What a l'efuge a leprosarium would have been to 
this poor woman ! She would then not only have had good medical 
care and nursing, but the ostracism of her family would have ceased. 

Case 54~ — This man, a Norwegian, died at the age of 30, in 1897. 
His was the aneesthetie form of the disease. The records show noth- 
ing for this man further than that he was single and poor. Undoubt- 
edly a leprosarium would have been the proper place for him. 

Case 55. — This man, a Norwegian, is still living, aged 57 } x ears. 
He has the anaesthetic form of the disease, which first made its appear- 
ance in 1874 or earlier. He is single and a county charge. When 
first seen by me, in 1898, he was serving as a school janitor, but when 
the nature of his disease became known he could no longer get employ- 
ment. He is much crippled. A leprosarium would be a great blessing 
to this man. He says he had no leprous relations, but had leprous 
neighbors in Norway. 

Case 56. — This man, from Sweden, is living, aged 39 years, and is 
able to support himself; but the time will soon come when he will 
become a public charge, and then he will probably be given the priv- 
ilege of dying in a "pesthouse." His is the tubercular form of the 
disease. It made its first appearance in 1892, and was then diagnosed 
as syphilis. He has a wife and two children, aged 13 and 10 years, 
all living and free from any symptoms of leprosy. A leprosarium 
will be the proper place for this man soon, although his condition has 
not changed much for the worse during the past two and a half years. 
He was associated with lepers as a lumberman in Sweden. 

Case 57. — This man, from Sweden, is living, aged 12 years. His is 
the tubercular form of the disease. It is said to have first made its 
appearance in 1888, six years after his landing in America. He is 



60 LEPROSY IN THE UNITED STATES. 

comfortable, in his own home on a farm, well cared for by his wife. 
He has four children, all girls. The wife and children show no signs 
of leprosy. The neighbors seem sensible, and there is no tendency to 
ostracise the family. He is a fortunate leper. 

Case 58. — This woman, a Norwegian, died at the age of 28, in 1890. 
Hers was the anaesthetic form of the disease. She had been in a leper 
hospital in Norway, and her relations state that she was discharged 
4 'cured. " The disease first appeared in 1874, when she was twelve years 
old. She came to America in 1887. She died of pneumonia, after one 
month's illness. She was never known as a leper in the community 
where she lived in this country. Her home was comfortable, and she 
was well cared for. She was not married. 

Case 59. — This woman, from Sweden, died at the age of 55 years, 
but a few days ago. Hers was the mixed type of lepros} T . It first 
appeared as the anaesthetic type, in 1886. She was married and had 
six children, two of whom (girls) are still living, as is also the hus- 
band. None of these show any symptoms of leprosy. If there was a 
chance for infection it would seem as though it might have occurred 
in this family, for the woman was filthy in her habits. Fortunately 
her husband and children had a dread of the disease, and this served 
as a safeguard. Even in this favored state I would not have been will- 
ing to have taken a chance against contracting this disease while living 
in this woman's home. A leprosarium was the place for this patient, 
but she is beyond its benefits now. 

Case 60. — This man, a Norwegian, died at the age of 35, in 1898. 
His was the tubercular form of the disease. It is said to have first 
appeared in 1888, but this was the year that he came to America. He 
was married and had one child. His wife was devoted to him, and he 
could not have had better care than that given him during his last 
illness. Neither his wife nor child show any signs of leprosy. A 
leprosarium would have been of no benefit to this leper. 

Case 61. — This man, a Norwegian, is still living, aged 67 years. 
His is the tubercular form of the disease. He is married and has eight 
children. Neither his wife nor children show any signs of the 
disease. He is quite well cared for at home. He has a brother in a 
leper hospital in Norway. 

Case 62. — This man, a Norwegian, is still living, aged 41 years. His 
is the tubercular form of the disease. It is said to have first made its 
appearance in 1893, seven years after his coming to America. In 1899 
the question of returning this patient to Norway was under considera- 
tion, but the opportunity was allowed to pass, and he is now blind and 
helpless — a pauper. A leprosarium is the place for him. He is now 
a county charge. He has never been married. 

Case 63. — This man, from Sweden, is still living, aged 44 years. 
His is the mixed form of leprosy. The disease is said to have been 



LEPROSY IN THE UNITED STATER. 61 

first noticed in 1893, eleven years after he came to America. He was 
a laboring man as long as he was able to work, but now is a pauper. 
He has not been married. His mother, one brother, and one sister died 
of leprosy in Sweden. Undoubtedly the place for this man is a 
leprosarium. 

Case 64,. — This man, a Norwegian, is still living, aged 55 years. 
His is the anaesthetic form of the disease, and is quite mild. Prob- 
ably only his physicians and intimate friends know that he is a leper. 
The disease is said to have first appeared in 1893, eight years after 
his having come to America. So far as known his general surround- 
ings are good and he is comfortable at home. His wife and three 
children show no S}^mptoms of leprosy. 

Case 65. — This man, a Norwegian, is still living, aged about 32. 
His is the mixed form of the disease. He states that the disease first 
appeared in 1898 (this is questionable). He has the leonine counte- 
nance, but by one not a close observer would not be thought of as a 
leper. He is able to attend to business. His wife and two children, 
aged six and three years, show no signs of leprosy. He came to 
America in 1888. His mother and one sister died of leprosy in Nor- 
way. He says his condition is improving under "Christian science" 
treatment, but appearances, when 1 last saw him, did not bear him out. 

Case 66. — This man, a Norwegian, died at the age of 73, in 1899. 
His was the anaesthetic form of the disease. It is said to have ap- 
peared twenty-two }^ears before his death and one } r ear after landing 
in America (not probable). He admitted having had one leprous 
cousin. He was a pauper for years and finally died at the county 
poor farm. He was not married, so far as known. 

Case 67. — This man, a Norwegian, died at the age of 12 years, in 
1898. His was the tubercular form of the disease. The disease was 
first recognized in 1876, when he was 20 } r ears old. He came to 
America in 1877, but, finding no improvement, he returned to Norway 
about 1880. I think he was in a leper hospital in Norwa}^. He was 
self-supporting while in Minnesota. He was single. 

Case 68. — This man, a Norwegian, is still living. He has but recently 
been reported to the Minnesota State Board of Health, and there has 
not been time to investigate the case. From the description given, 
this is the tubercular type of the disease. The neighbors are afraid of 
this man and shun him as one unclean. 

Case 69. — This man, a Norwegian, is still living. His is the tuber- 
cular form of the disease. He is a laborer, 31 years old, and single. 
He came to America about seven years ago, and then had leprosy in 
its early stages. Probably he will become a public charge as he grows 
worse and becomes unable to work. 

Case 70.- — This man, a Norwegian, may possibly be in our records 
without designation. He was a brother of case 32, and died in 1895. 



62 LEPEOSY IN THE UNITED STATES. 

I can find no facts on file relative to the case. The father of these two 
cases also died of leprosy, and is probably one of the early cases on 
our records without a name. (Case A, p. 22.) 

Case 71. — This man, a Norwegian, came to Minnesota, a leper, about 
1890. He was then about 20 years old. His trip here was to see if 
his condition would not improve in this climate. There being no appar- 
ent improvement, he returned to Norway about 1897. His was not 
a marked case of leprosy. While resident in this country he was 
self-supporting. It is not known positively that he is dead. 

Case 72. — This man, a Norwegian, is still living, at the age of 22. 
His is the tubercular form of the disease. The symptoms of leprosy 
are said to have appeared about five years ago, six years after his com- 
ing to America. He is single and destitute and cared for as a public 
charge, at an annual cost of $650. He lives in a part of the country 
where the people are unnecessarily alarmed over a leper, and for this 
reason he has to be given special care. This patient should certainly 
be in a leprosarium. 

Case 73. — This man, a Norwegian, is still living, and a prisoner for 
the remainder of his life, which will probably not be long. His is the 
tubercular form of the disease. He was born in 1847 and came to 
America in 1882. His case was first diagnosticated as leprosy in 1893. 
Soon after this it became known in his neighborhood that he was 
leprous, and the process of ostracising him and his family began. He 
lived on a farm and was prosperous. It became necessary for the 
county commissioners to separate him from his family and to place 
him in a house alone, although on his own place, with another leper, 
less advanced with the disease, to care for him. The community fol- 
lowed out the Bible inj unction to the limit in treating this man and his 
family as unclean. The house in which he lives is about a quarter of 
a mile from the house in which his family lives. His wife cooks for 
him and his attendant, and the food is carried and placed at a safe dis- 
tance from their prison three times a day. It costs the county in which 
he lives about $600 per annum to care for him. His wife and six 
children, ranging in age from 10 to 22 years, although perfectly 
healthy and entirely separated from the patient, are practically ostra- 
cised. When it was found that the children had a legal right to attend 
school, they and two families related to them were allowed full owner- 
ship of the school building, and the school directors set about building 
another schoolhouse for the rest of the children of the district. I am 
happy in the fact that this kind of treatment is not as a rule given to 
lepers or their families in Minnesota. 

Case 7 If. — This man, from Sweden, is the keeper of case 73. He has 
the tubercular form of the disease. He is poor, is single, and will be 
a charge upon the county as long as he lives unless there is some other 
provision made, State or national, for the care of lepers. His cost 



LEPEOSY IN THE UNITED STATES. 63 

is estimated at 8600 per annum. He has been resident in the State 
four years and has been in the United States seven years. He admits 
having noticed swelling of the face in 1897. 

Case 7£a. — This case is interesting because not leprous. He was 
reported to me as an American-born leper. Investigation revealed 
the following: A child. 11 years old, was born in the State where he 
now resides of healthy Norwegian parents. He has eight brothers and 
sisters living, all healthy. When about 1 year old he had '* cholera 
morbus," but no physician was in attendance. He apparently recov- 
ered from this and learned to walk a little, but later the gait became 
irregular and the power of walking was lost entirely in 1890. Paraly- 
sis of the lower extremities became complete. At present the chest, 
shoulders, head, etc., are well developed, but the lower extremities 
are small. The thighs are flexed on abdomen and to the left, so that 
as the child lies on his back his knees rest on the bed at his left side. 
The skin is very fair. The boy seems bright and has a good face. 
The parents try to take good care of him. but are not as cleanly as they 
should be. AY here the body comes in contact with the bed there is a line 
of dirt upon the skin and a scaly eruption — a filth eczema. There are 
eruptions on various parts of the bodj~, due to contact of a sensitive 
skin with soiled bedding or to bites. There are also bed sores. It 
was worth the hard drive that I made of about 100 miles one Sunday 
to see this case to be able to say not leprous, and that I have yet to 
learn of the first American-born leper in this section of the country. 

Case 75. — This woman's history, and the fact that she was well cared 
for during her latter days, is set forth in the records of the Johns 
Hopkins Hospital. The necessity for leprosaria is well demonstrated 
by the treatment this patient would have received but for the hospital 
already named. She was an American who contracted the disease 
(tubercular form) in the West Indies. She died in 1900. She was a 
public charge for three years. No children living. 

Case 76. — This woman, an American, has been a leper for 10 years. 
She is now 78 years old. Hers was at first of the anaesthetic form, 
but is becoming more and more tubercular in character. She has been 
a public charge for eight years, at a cost of 81,000 per annum. She 
would be a proper case for a well organized leprosarium. I do not 
know whether she has had children. 

Case 77. — This man, from Sweden, died at the age of 10 years, this 
year (1900). His was of the mixed type of the disease. It first 
appeared in 1888. He was a public charge for ten years before his 
death. He was never married. 

Case 78. — This man. an American, contracted the disease in Brazil, 
and died at the age of H years, this year (1900). He returned to Pitts- 
burg in 1879, and the disease has a history dating from 1882. His 
was the mixed form of the disease. He was a public charge for four 



64 



LEPEOSY IN THE UNITED STATES. 



years prior to his death, at a cost of $1,200 per annum. He was mar- 
ried, but none of his relatives are leprous. 

Case 79. — A Chinaman, died in 1897. He had been a public charge 
for seven years. 

Case 80. — A Chinaman, died . His was tubercular leprosy. 

He was a public charge for several years. 

Case 81. — A Chinese laundryman, was found to be leprous. He was 
placed in a county hospital, where he died eventually. 

Case 82. — Of this case I have no data. 



UNOFFICIAL LIST OF LEPERS. 

Case 1. — This man, a Mexican, was recognized as a leper. He was 
self-supporting, and when people became suspicious as to the nature 
of his disease he disappeared. His was the tubercular form of the 
disease. 

Case 2. — An American physician, who had been a good deal of a 
traveler, contracted the disease abroad, and died in this country in a 
hospital. The iinal illness was of short duration. 

Case 3. — A Chinaman, discovered to be leprous, was advised to move 
on. He did so. It is stated that he wanted to return to China, and 
he was given means to do so. It is not known whether he followed 
his inclination in this matter or not. 

Case Jf. — A Greek; when found to be leprous he returned to his own 
countiy. 

Case 5. — A typically leprous Norwegian woman. When she learned 
that she was to be examined for leprosy she disappeared. 

Case 6. — A Norwegian is spoken of as returning to his native coun- 
try in 1891 to enter a leper hospital. 

Case 7. — A Norwegian resident who is classed among the "cured" 
lepers. His name and residence are known only by his physician, 
who is pledged to secrecy. 

Case 8. — A Norwegian who lived in a district where lepers were 
shunned with a vengeance. When his disease was recognized he was 
supplied with money and sent, with his family, to Norwa} r . The 
house in which he lived (not an expensive one, I presume) was bought 
by the neighbors and burned to the ground. 

Cases 9 to 21, inclusive. — These are all Icelanders. None of them 
are known to be leprous in the communities where they live. None 
of them are American born. In some the disease is said to be 
"arrested." 

Case 22. — This was a Chinaman in a neighborhood where there had 
already been a great deal of trouble over leprosy. When his condi- 
tion was recognized he disappeared from the locality, but probabty 
not from the State. (See Case E, p. 23.) 



LEPEOSY IN THE UNITED STATES. 65 

Case 23. — This is a Norwegian woman whose name ought to be in 
the- official list of one of the States, but is not. She is probably dead, 
for in 1889 she is described as being 58 years old and affected with 
tubercular leprosy. 

Case 2 %. — This man, a Norwegian, ought to be upon the official list, 

but his name was secured October 15, a date too late to allow of further 

investigation. 

Case 25. — This man, a Norwegian, had the mixed form of leprosy. 

He died about 1888. He was kept in a private house, having certain 

rooms given up to him exclusively. He was a single man. Not a 

public charge. 

. SPECIAL CLASS. 

Case A. — This man, a Norwegian, was one of the early lepers in 
Minnesota, and died many years ago. There is no positive record of 
this case, but it is probable that he represents one of the first three in 
the Minnesota list (case 10, 11, or 12). . He came from a leprous district 
in Norway. Two of his sons died in Minnesota of leprosy (cases 32 
and 70). 

Case B. — This man, a Norwegian, died of leprosy about 1884. None 
of the records on file are known positively to refer to him, but in this, 
as in preceding case, it is probable that he represents one of the first 
three in the Minnesota list (case 10, 11, or 12). Quite recently I was 
asked to investigate the descendants of this man, for some of them 
were suspected of being leprous; but the suspicion was groundless. 
He has children and grandchildren living, none of whom show any 
signs of leprosy. Tuberculosis has brought death to many of his 
descendants, and the conditions of some of these tuberculous patients 
had suggested to the suspicious the possibility of leprosy. 

Cases C and D. — Nothing is known of these cases further than that 
they came from Canada, and were about to settle in northern Minne- 
sota when they learned that they were to be examined as to their being 
lepers. Thereupon the}^ returned to Canada. It is quite possible that 
these were Icelanders, for there are many such in Manitoba, and lep- 
ros}^ is not an uncommon disease among them. 

Case E.— A Chinaman presented himself to a physician for an opin- 
ion as to whether he was leprous or not. He stated that an opinion 
had been given in the affirmative. He was requested to call at the 
physician's office for an examination, but never did so. As this occurred 
in the State where case 22 was given money and told to clear out, it is 
quite possible that the two are one and the same. 

S. Doc. 269 5 



66 LEPROSY IN THE UNITED STATES. 



STATISTICS FROM OTHER PARTS OF THE UNITED STATES. 

Leprosy statistics from other parts of the United States may be of 
interest at this point. Dr. Morrow in his article in the "Twentieth 
Century Practice of Medicine," Vol. XVIII (1899), reports as follows: 

For California, a total of 196, at present 26; South Carolina, a total of 16; Texas, a 
total of 34; Louisiana, a total of 277, at present 131. 

Dr. Hyde, to the Congress of American Physicians and Surgeons 
(1894) reported for other States the total as follows: 

Arkansas, 3; Dakota, 2; Florida, 6; Georgia, 1; Idaho, 1; Illinois, 13; Indiana, 2; 
Iowa, 20; Maryland, 4; Massachusetts, 5; Minnesota, 120; Missouri, 2; Mississippi, 2; 
New York, 100; New Jersey, 1; Oregon, 3; Pennsylvania, 6; Utah, 3; Wisconsin, 20. 

My own records for certain States compared with Dr. Hyde's are as 
follows : 






North Dakota . 
South Dakota . 

Iowa 

Minnesota 

New Jersey 

Ohio 

Pennsylvania 
Wisconsin 



Dr. Hyde. 



20 

120 

1 



6 

20 



Present 
paper. 



2 
1 
3 

61 
1 
1 
6 



I presume Dr. Hyde's figures for Iowa and Wisconsin are estimated. 
Probably they are not too high. I have taken only those cases of 
which a history could be given. It is probable that the 120 cases cred- 
ited to Minnesota are taken from Dr. Hansen's report. It seems to 
me this, too, must be an estimate. Dr. C. Gronvold was in close 
touch with Dr. Hansen when he visited Minnesota. If there were 120 
cases in the State, I can not understand why they are not on our 
records. If there were that many cases in 1888 the number for Min- 
nesota is much higher than I have given, for many of the cases in our 
official list can not have possibly belonged to Dr. Hansen's 120. 

Dr. Morrow's article, already referred to, states that the Tracadie 
(New Brunswick) lazaretto has admitted altogether 150 lepers, and that 
in 1899 there were still 23 inmates. He also assigns 11 as a total for 
Cape Breton and 10 for British Columbia. 

Mexico has her proportion of lepers. 

It might appear from the report of cases in the Northwest that 
leprosy was far more common in Minnesota than in the neighboring 
States. I can see no reason for this belief, however, for the lepers in 
this district are among the immigrants from Norway, Sweden, Iceland, 
and China. These people have quite a representation in all this group 
of States. I can only attribute the more complete returns from Min- 
nesota to the fact (1) that there has been less agitation against leprosy 



LEPROSY IN THE UNITED STATES. 67 

in this than in some of the neighboring States; (2) that with this lack 
of agitation against leprosy physicians report their cases more willingly 
to the State board of health, which has endeavored during the last 
twenty years to palliate the sufferings of this unfortunate class; (3) 
that Minnesota is fortunate in having among its physicians men who are 
familiar with leprosy and who are interested in philanthropic work; and 
these physicians have given material aid to the State authorities engaged 
in securing a list of all lepers in Minnesota. It may be worthy of note 
that several lepers in the Minnesota list give the history of a previous 
residence in Wisconsin, but their names in not a single instance appear 
upon the Wisconsin records. It might seem to some that, in discuss- 
ing the lepros} T question, it was only necessaiy to consider those cases 
now living; but if we are to judge of future needs we must know con- 
ditions of the past as well as of the present. Of the 37 living lepers 
known to be resident in the Northwest, permit me to state that 17 only 
are in Minnesota, and there is a strong possibility of 2 of these being 
dead, but we have no positive knowledge of the fact. 

It does not seem that all parts of the country are favored as are 
Minnesota and adjoining States, where not a single American-born 
leper is found, even among the descendants from a leprous parent. . 

I do not dwell upon these facts as an alarmist, but simply to remind 
you that leprosy has existed, does exist, and will continue to exist for 
years to come in all three countries represented in this association. 

Were we to look only at the disease and its future it might be dis- 
missed without further consideration of the group of northwestern 
States especially referred to in this report. But we must admit that 
imported cases will continue to appear even here, and humanity demands 
that such should be cared for rather than to allow them to drag through 
years of suffering. 

With this presentation of facts, I think all will admit the need of 
leprosaria, and most of you, I doubt not, will feel that the nation is 
better fitted than any one State to establish and maintain them. It is 
impossible for a single State, even though it may have a considerable 
number of lepers, to provide for them at a reasonable rate or to make 
them comfortable. Louisiana is the only State that has tried to 
establish a leper colony. In many States lepers are cared for as 
paupers, but the}" can not be allowed to associate with other paupers; 
hence, they are cared for in "isolation wards," which are, as a rule, 
veritable prisons, and often a hell on earth. 

The uninfected have an inherited dread of leprosy. They do not 
appreciate that tuberculosis, syphilis, and many other preventable 
diseases are far more dangerous than is leprosy. Hence comes the 
unreasonable persecution of the leper. If a laborer, he is no longer 
able to secure emplojmient. If an individual living in comparative 
comfort, the cry goes out through his neighborhood "Unclean! 



68 



LEPROSY IN THE UNITED STATES. 



Unclean!" and, in consequence, his neighbors shun not only the leper 
himself but all those who are associated with him. His family is 
ostracized. His children are either excluded from school or their sur- 
roundings are made so uncomfortable that they by choice prefer to 
stay away. I have seen a f amity, with children ranging in age from 
10 to 22 years, which was practically shut out from the world, because, 
forsooth, the father was a leper. He did not live with the family or 
have any intercourse with it, and yet the ostracism was complete 
against all its members. 

With a husband depending upon his work at a trade to support his 
family, and who could not get employment because of his wife's illness; 
with children approaching school age who were practically shut out of 
school on account of the mother's condition, I have seen a poor woman 
pray for death to come and release her and them, and yet she lived for 
years under just such suffering. 

I have knowledge of a single man, by no means a source of danger, 
who was driven out of the community in which he lived. He had 
means sufficient to supply his wants. The people with whom he lived 
knew how to care for him properly and were willing to do so. He was 
blind, yet public sentiment drove him away and made him homeless. 
A State refused to allow him to travel through it by rail, and a car 
containing this unfortunate man was sidetracked. It is hard to imag- 
ine what might have become of him had not a good Samaritan, a phy- 
sician, gone after him, and driven with him a hundred miles or more 
across country to his own home, where he kept him until he was able 
to find a safe and somewhat permanent retreat for him. Truly a lep- 
rosarium of the right kind would be a blessing to all lepers subjected 
to such indignities. It is not only the leper who is financially poor 
who demands our thoughtful care. 

I have seen leper colonies that were nothing but places of abode for 
the living dead. Far be it from me to urge the establishment of such 
places in our country. Let us consider briefly what we should find in 
a leprosarium, and then decide whether we are to work for the estab- 
lishment of our ideals. 

A leprosarium should afford a comfortable home for lepers. This 
means not only good buildings, but extensive grounds comprising many 
acres, where the lepers may' have liberties and still be in exclusion. 
The buildings connected with the leprosarium must combine the 
privileges of a home and of a hospital. Those who have the disease 
in mild form may need little, if any, medical care. They need com- 
fortable clothing and good food. With those in whom the disease 
is more advanced, the care should be that of a hospital patient, with 
medicines to lessen their sufferings and dressings that would commend 
themselves to any surgeon. 

A leprosarium should resemble our modern colonies for epileptics.. 



LEPKOSY IN THE UNITED STATES. 69 

It should furnish employment for those who are able to work, and 
amusement of various kinds for all. 

The patients ordinarily found in hospitals stay in them for possibly 
a few weeks, and then return to home and friends. Not so with the 
leper. He is an outcast — a patient for life — but not necessarily con- 
fined to bed except for brief periods. 

In establishing leprosaria we must give some thought to the lepers 
and their disease. It would not be humane to transport those who by 
inheritance and birth belong in a tropical climate to a leprosarium in 
Minnesota, while on the other hand people of Scandinavian or Ice- 
landic origin should not be sent to Louisiana or the Hawaiian Islands. 
It would seem, therefore, that at least two leprosaria were needed in 
the United States. The time is ripe for taking hold of this matter. 
The committee of which I as chairman present this paper was created 
by this association two years ago because the need of such humane 
action was recognized as a necessity. The replies to the circular letter 
which I sent out, tabulated on pp. 11-42, seem to show that sanitarians 
generally recognize both the need of leprosaria and the fact that they 
should be national rather than State institutions. California has 
alread}^ memorialized Congress in favor of the national care of lepers. 
Louisiana, I doubt not, would be glad to transfer her lepers from 
their present place of abode to a national leprosarium such as I have 
presented in outline. 

Two of the strongest medical societies in Minnesota have placed 
themselves on record as favoring the establishment of national leprosaria. 
The American Dermatological Association has a committee appointed 
to determine, if possible, the best methods to be used in the care of 
lepers. It would seem that this association should be ready to place 
itself on record as anxious to find some solution for this vexed propo- 
sition. One thing is certain, we will have lepers in this country for 
years to come, whether imported or of our own production. The 
thing for us to do is to recognize the fact and meet it. The questions 
involved are those of sanitation and humanity. Sanitarians are, as a 
rule, humanitarians, and as we are a recognized body of sanitarians, it 
is time to act. I therefore, in closing this paper, propose the follow- 
ing resolution : 

Whereas it is a known fact that lepers are found in Canada, the 
United States, and Mexico; that these lepers represent immigrants of 
many nationalities, together with some Americans; that the exclusion 
of leprous immigrants by inspection is impossible; that the tendency 
to importation of leprous immigrants in the future will be greater 
even than in the past; that the danger of infection of American resi- 
dents abroad and the importation of the disease through these chan- 
nels is greatly increased: Therefore, be it 

Resolved, That this association place itself on record as favorable to 



70 LEPROSY IN THE UNITED STATES. 

the establishment of national leprosaria, which may serve, not only as 
a refuge for lepers, but also as homes and hospitals, making their lives 
tolerable as far as possible, furnishing employment to those who are 
able to work, and giving skilled medical care to all cases, with the 
intent of possibly curing some, and making the road to death less weari- 
some and painful than it now is to others. 



[ Letter from Dr. Wingate.] 

State of Wisconsin, 

State Board of Health, 

Milwaukee, Wis. ,• July <2, 1900. 
My Dear Sir: I have the honor to submit herewith a report in 
answer to your circular letter relative to leprosy in this State. 1 have 
delayed answering, as I have written to all parts of the State where 
leprosy has ever existed. Have made as thorough an investigation as 
I can, and am unable to find but the two cases herewith reported. 
Formerly there were some thirty cases in the State — that is to say, ten 
or fifteen years ago — but they have all died off but these two. We 
have never been able to learn that the disease has been contracted or 
has ever developed in this State. A\\ of the persons affected came to 
the State suffering with the disease, or have developed it here from 
inherited conditions. 

Respectfully, yours, 

U. O. B. Wingate, M. D. 
Dr. J. H. White, 

Chairman Leprosy Commission, Washington, D. C. 



[Letter from Isadore Dyer] 

New Orleans, La. , December 19, 1900. 

Dear Doctor: I am sending you herewith a list of cases of leprosy 
which I have been able to collect for you. I am in hopes of adding 
some thirty more from one or two of the parishes, and, after revising 
my own list, I may be able to find some that I have missed. 

I believe that it is timely for me to express some opinion to you 
regarding the status of leprosy conditions here in Louisiana, particu- 
arly as I feel that your board is aimed at remedying existing condi- 
tions in this country. 

In 1894 the present leper home came into existence with the object 
of providing an asylum for lepers, to which the law compelled all 
reported cases to be sent under a regular commitment. During the 
six years of existence of the institution the management has been 
almost entirely in the hands of the laymen, very little interested in the 






LEPROSY IN THE UNITED STATES. 71 

medical care of these cases and, therefore, in nowise on the lookout for 
increasing the number of patients in the institution. The result has 
been that in the face of a large number of patients in the State the 
total number received at the institution has aggregated about forty, of 
which some twenty -five are now living at the home. Of the total num 
ber, about ten have been legally sent; the balance have been persuaded 
to go or have voluntarily entered the home. 

I believe that under the system at present in vogue it will be impos- 
sible to handle the question of leprosy in this State. Further than this, 
I think that the most active investigation of the disease is necessary 
to prevent the further spread, and I believe that the solution lies in the 
establishment of a national asjdum. There are already evidences of 
leprosy in the neighboring States of Texas and Mississippi, while in 
Louisiana, of 59 parishes, more than half have leprosy within their 
confines. Those parishes most affected lie around New Orleans, and 
in the history of the spread of the disease one parish after another has 
become infected, and in a graphic way demonstrating the spread to be 
almost directly in the line of adjacent contact. 

In New Orleans itself a large majority of the cases have acquired 
the disease in the old French section of the city, where leprosy has 
existed for over one hundred years. In my observation the disease 
seems to be rapidly on the increase, as the bulk of the cases I report 
have developed within the last five years. A great many of them 
apply for treatment with a history of only three or four months' 
duration of the disease. The type predominating in the beginning is 
tubercular, with comparatively few purely nerve cases, an argument 
prima facie of the active nature of the contagion. 

My interest has always been public spirited, and it has been unfor- 
tunate in that the people of this section are absolutely indifferent to 
the dangers of such a disease. 

I sincerely trust that the work that you have begun may prove 

eventful, and I shall be glad to serve in all ways to further the object 

aimed at. 

Yours, very truly, 

Isadore Dyer. 
Dr. J. H. White, 

Chairman Leprosy Commission, Washington, D. C. 



[Letter from Dr. Isadore Dyer.] 

New Orleans, September 16, 1901. 
Dear Doctor: The duplicate list, etc., received. 
I am sending jou additional names, together with a discursive opin- 
ion, as you requested, regarding the establishment of an asylum. ' 
I hope you will keep me in touch with the reports and the probable 



72 LEPROSY IN THE UNITED STATES. 

date, so that we may get our Representatives in Congress interested 
in any projected legislation. 

Should any other cases develop, I shall send the list. 
Very truly, yours, 

Isadoee Dyer. 
Dr. J. H. White, 

Chairman Leprosy Commission, Washington, D. C 



[Inclosure.] 

The history of leprosy in every country where it has been introduced 
evidences the fact that the disease has always flourished until some kind 
of segregation and isolation were obtained. 

In Europe little attention was paid to the malady until by the twelfth 
century it had become widespread. Then lazarettos were established 
by the hundreds, and barbaric ostracism was practiced. 

Modern instances of the spread of leprosy are evidenced by the con- 
ditions in the Hawaiian Islands, where leprosy has been endemic only 
about fifty years; in Louisiana, where it has gradually grown into an 
endemic disease in about one hundred years, and in modern Europe, 
where in recent years the reappearance of the disease created enough 
alarm to demand and to secure legal control of the disease. 

It is quite beyond argument that the segregation of lepers in time 
destroys the disease by eliminating the element of contagion, now 
conceded as the method of spread of the disease. 

The mission work in India, in addition to that maintained by the 
British Government, is gradually bringing about some reduction in 
the amount of lepros}^ in that hotbed of the disease. 

Almost all of the European Governments have established institu- 
tions for the segregation of lepers. Several of these countries have 
passed stringent laws regarding the ingress and egress of lepers in the 
country. 

Therapeutic measures in leprosy are still in the experimental stage, 
but there are several agents of decided value in ameliorating the disease 
and exceptionally in curing it. 

The exact status of leprosy in the United States may not be known 
for some time to come. The difficulties in the way of learning the 
numerical occurrence of the disease are many. The ignorance as to 
diagnosis is one large factor, and the personal equation between doctor 
and patient another. 

The fact, however, that leprosy has been demonstrated as endemic 
in Louisiana, probably so in California also, and that it occurs in num- 
bers in New York and Minnesota, with straggling cases all over the 
country moving from place to place, all points to the need of some 
universal action for its control. This deduction is evident, for the 



LEPEOSY IN THE UNITED STATES. 73 

reason that if one State legislates against leprosy, the victims of the 
disease emigrate. This has occurred in the case of Louisiana when 
the leper laws of 1890 and 1894 were promulgated. 

There should be a national leper asylum, and it should be modeled 
on the broadest humanitarian plane. This asylum, and there might be 
more than one as the occasion directs, should be located conveniently 
near to the known centers of the disease. The institution should 
be conceived upon the plan of a colony, with all provision for the 
domestic comfort and the physical content of the inmates. There 
should be provision for the amusement and education of the young 
and adult. 

The institution should have complete hospital facilities, with all that 
is to-day necessary for a well-equipped hospital, including a laboratory 
and hydro therapic outfit. The pavilion system should prevail; fami- 
lies should not be separated, and a domestic scheme should be arranged. 

To-day the possibility of the cure of leprosy is no longer chimeric, 
and if it is to be cured, the United States in establishing a refuge 
for the victims of the disease should at the same time essay all means 
to solve the problem of the treatment of the malady. 

It is my belief that the successful treatment of the disease depends 
as much on routine in treatment with drugs, and in regular hygiene, 
baths, etc., as in specifics. 

If the Marine-Hospital Service is to assume charge of such an insti- 
tution, its detail of surgeons should be for a long enough period to 
allow proper service in such an important work. 

I believe, however, that the administration of such an as}dum should 
be separate from any of the established departments of the Govern- 
ment, as then more specific and direct service could be given, without 
the frequent likelihood of change or interference through the routine 
and discipline in vogue with the Government services, Army, Navy, 

and Marine Hospital. 

Isadore Dyer. 
September 16, 1901. 



[The Washington Post, Sunday, June 16, 1901.] 

LEPERS OF LOUISIANA — A PLACE OF ETERNAL EXILE ON THE MISSISSIPPI 
RIVER — ALL THE CASES ARE HOPELESS — ABOUT 15 ACRES ARE INCLOSED 

IN THE LEPER COLONY ON THREE SIDES IS A FOREST, AND ON THE 

FOURTH IS A RIVER — HOW THE MEN AND WOMEN ARE LODGED AND 
CARED FOR— NEARLY 200 LEPERS IN THE STATE ARE HARBORED 
SECRETLY BY FRIENDS. 

There is a place behind the levee on the east bank of the Mississippi, 
80 miles above New Orleans, that the river boats pass in the early 
morning long before the passengers leave their berths, so it is not 



74 LEPROSY IN THE UNITED STATES. 

pointed out as one of the sights of the river. Perhaps it would not 
be pointed out anyway, as it could hardly be expected to enhance the 
attractiveness of the route. The lazy plantation negro passing it on 
the river road "gets a gait on" his mule, because of a superstitious 
dread; and to those even who fear only the material, the eerie atmos- 
phere brings a shudder. The character of the place is little known , 
except to the Creoles of Iberville, the parish in which it lies, and to 
the steamboat men who bring supplies to it. An uninformed person 
would suppose it was only one of the several deserted plantations to 
be seen along the Mississippi, relics of Louisiana's "'fo' de wah" 
glory, though a larger and grander ruin than the others. Such it was 
until 1894, when put to its present use. It is now a leper colony, the 
only institution of its kind in the United States. 

When arrangements were made in 1894 for the removal of the band 
of lepers hitherto confined in a pesthouse on the outskirts of New 
Orleans, to the old and long-deserted mansion in Iberville Parish, the 
residents of the parish threatened to attack the invading force and 
burn down the place. When they learned, however, that the State 
officials stood read}^ to back the project with a military force, they 
gave in. Late on the night of November 30 the melancholy proces- 
sion moved out from the pesthouse and climbed into covered wagons, 
which were driven to the river front, where a barge towed by a tug 
was awaiting them. No steamer would convey them, fearing to hurt 
its passenger traffic. In the morning they were safely lodged in their 
new quarters, and there began for them an easier and pleasanter life 
than they had known since the relentless law had shut them off from 
their fellow-men. 

BURIED WITHIN THE COLONY. 

The leper settlement proper is inclosed by a high board fence, out- 
side of which none of the lepers are ever allowed; not even after death, 
for they are buried in their own little cemeterv, in the southeast corner 
of the inclosure. About 15 acres are inclosed. On three sides of this 
is a thick forest, on the fourth the river. The two long rows of cot- 
tages that were once slave quarters have been repaired and are now 
the homes of the lepers. The men occupy one row and the women the 
other. Between the rows a double line of moss-covered oaks runs the 
entire length. On the men's side, in the space between their cottages 
and the fence, is a vegetable garden that the able-bodied among them 
work. On the women's side is a flower garden that occupies much of 
their time. 

One of the cottages on the women's side is used as a chapel. The 
dining room is the half of a raised cottage that crosses the inclosing 
fence. Those who are able walk to their meals and help the sisters 



LEPEOSY IN THE UNITED STATES. 75 

attend the others. The half of this house without the inclosure is used 
by Father Claffey, the priest now ministering to the institution. 

When the new site was decided upon the Sisters of Charity were 
asked to take charge of it. The mother superior of the organization 
asked for volunteers, for she would send no others on such a mission. 
Some said they would go anywhere they were sent, but could never 
volunteer for this fearful work. Four gave up their lives to the care 
of the lepers. To this number, a Miss Dehan, not a sister, added her 
services. Several priests have been assigned to serve for short periods 
until relieved. As yet none have contracted the disease. The}^ live 
apart from the lepers entirely, and when waiting upon them or caring 
for them they wear gloves. This noble little band has made the home 
a home indeed, but their toils have not eradicated the horror of the 
place felt among the lepers of the outer world who have succeeded in 
preserving the secret of their affliction. The law of the State pro- 
vides that all lepers shall be committed to this institution, but the law 
is not enforced. There are now 32 lepers confined here, while nearly 
200 are harbored secretly in their homes. 

IDENTITY OF LEPERS KEPT SECRET. 

The identity of those confined at the institution is maintained a pro- 
found secret, and few outsiders are allowed to enter the place. A 
permit, by no means easy to obtain, must be presented before a visitor 
is admitted. The most tragic cases at the institution are two young 
girls, both of them beautiful, cultured, and members of prominent 
Louisiana families. Not a mark has yet appeared upon the face of 
either, but they wear gloves always. When the writer visited the 
inclosure these girls were sitting in the garden reading to several 
children and old men. A sister introduced the writer to the girls with- 
out mentioning their names. Both talked cheerfulh T and without 
reference to their terrible fate. Their cases are, of course, hopeless. 
All leprosy cases are. 

Life in the settlement is by no means as terrible for the most of the 
lepers as one might suppose. Many of them are perfectly able to do 
a good day's work, but no labor is required of them. What work is 
done they do of their own free will. Many of them take a pride in 
their gardens. For recreation, the liveliest of them play croquet and 
even lawn tennis, while those who are partly incapacitated carve 
wooden ornaments and crochet. They have all sorts of indoor games, 
and friends keep them supplied with reading matter. Complaining 
petulance or rebellion against their fate is almost unknown among 
these unfortunates. They await the inevitable end with a quiet touch- 
ing patience, treating each other with unfailing sweetness and tender- 
ness. They are a devoutly religious body. Marriage of course is not 
permitted among them. The children of the settlement were all 



76 LEPROSY IN THE UNITED STATES. 

legally assigned there with one or the other of their parents. Though 
leprosy is more prevalent among the negroes than among the whites, 
there are but seven negro inmates of the colony. There has been but 
one escape from the inclosure — that of a lad who scaled the fence and 
got safely away. About a month after he had gone the sisters received 
a letter, thanking them for all their kindness and informing them that 
he was on his way to the Sandwich Islands, where there was more 
scope for those of his affliction. 

CRUSADERS AGAINST THE EVIL. 

This institution is not the first leper colony in this country; it has 
had two predecessors, both in the same State. There has been leprosy 
in Louisiana since the Spanish regime. It was brought over to the 
province from the West Indies, and in 1786 the leprous beggars in 
the streets of New Orleans had become so numerous that the authori- 
ties had to establish a home and isolate them. The home was erected 
on Metarie Ridge, a high strip of land surrounded by swamps, just west 
of the city. It lasted fifteen years — until the patients disappeared, 
either b}^ death or escape. The crusade had ended after 40 had 
been ferreted out and incarcerated there, and then the unfortunate 
beings were left to eke out a doubtful existence. Little or no atten- 
tion was paid to them, further than the provision of funds to imburse 
the contractor for their care, and rumor has it that the lack of care 
and the desolate surroundings hastened deaths and warranted depar- 
tures. "Leper Land," as the spot was called, remained a wild-looking 
place until 1805, when a band of itinerant Indians pitched their tents 
upon it and tore down the rattletrap building for firewood. 

Relieved of this constant reminder of the prevalence of the disease, 
and hearing and seeing little of it because of the seclusion kept by the 
lepers, who feared another crusade against them, the public grew 
apathetic to or forgot the danger. So, on to 1878, the disease smol- 
dered in hidden quarters. In this time 80 cases were admitted to 
the Charity Hospital in New Orleans. The board of health became 
fearful at this juncture that so many should remain at large, and began 
a canvass to ascertain the exact number there were in the State, with 
a view to recommending to the legislature that they be again isolated. 
But, owing to a rumor persistently circulated that the authorities 
intended seizing the lepers and transporting them to an island in the 
Mexican gulf, and there abandoning them, considerable difficulty was 
experienced in locating them, and only 37 were ascertained. 

After two years the board succeeded in having the cases then under 
its surveillance consigned to a building in the suburbs set apart as a 
pest house. The history of this place is the same pitiful tale as 
the former — no management, a dearth of attendants, and those few 
inefficient or fearful of their duties. As new cases were discovered 



LEPROSY IN THE UNITED STATES. 77 

the} 7 were sent to this place. A number of cases developing in the 
proximity of this home and the old one was the cause of the State 
establishing another apart from all habitation. This was the present 
institution — as successful as such a colonv may be. 



[New Orleans Democrat. May 30. 1901.] 
A NATIONAL LEPER HOME. 

We publish elsewhere a communication from Dr. Albert S. Ash- 
mead, of New York, relative to the care of lepers. It is in support 
of a bill introduced in Congress at the last session by J. P. TTanger, of 
Pennsylvania, proposing to take away from the State boards of health 
the care of lepers and to give this care to the National Government, 
which is required to provide for and keep isolated all the lepers in 
this country or its Colonies. The bill was submitted to the State 
boards of health of nearly all the States, and generally approved by 
them, although some objection was raised to a provision giving the 
United States Marine-Hospital Service charge of the lepers, and it 
was proposed that a special national leper board be created instead, 
composed of men who understand the disease. In order not to infringe 
on the rights and privileges of the States, the bill provided that any 
State might turn its lepers over to the national board, to be cared for 
by it, but it was not obligated to do so. The bill also provided for the 
establishment of a national leper home and farm a mile square in a 
portion of the Yellowstone National Park, and near its center. This 
location was selected for the very reason that made the Elkhorn loca- 
tion in Jefferson Parish objectionable. Any measure would have been 
greeted with shouts of disapproval that located a leper home in any 
of the States. Congress had to select a site over which it had supreme 
jurisdiction, and far removed from an} r thickly settled neighborhood. 
On the other hand, the point chosen is so admirable in climate and 
surroundings that no possible objection can be heard from the lepers, 
who are sent to an earthly paradise. The climate is antileprous, for 
leprosy is restricted almost entirely to the seacoast, and is never found 
in any mountainous or elevated region. It is presumable, therefore, 
that its contagiousness will be lessened there, even if the lepers are 
not benefited by being removed from the seacoast to the mountains, 
as is hoped. 

This bill was before Congress at the last session but was not acted 
on. It will be introduced again at the coming session and vigorously 
pushed. It will certainly receive more consideration then, with the 
facts that will be brought to the attention of Congress. 

It has recently been shown that leprosy is increasing in the world, 
largely due to the failure of civilized countries to take the radical 
steps needed to crush it out. In the United States we have escaped 



78 LEPROSY IN THE UNITED STATES. 






the disease, except in a few States, but latterly it has been introduced 
into California from China and into Minnesota and Wisconsin from 
Scandinavia, where it prevails among the fisherfolk. By our recent 
acquisitions in the Pacific we have annexed lepers by the tens of thou- 
sands, and have been brought face to face with the problem. We have 
in Hawaii a leper colony, while leprosy is rampant in some of the 
Philippine Islands and is spreading. 

Under these circumstances the possibility of an increase in leprosy 
in the United States is so great that the country can not consent to 
hide its head much longer under its wing, but will have to take hold 
of this matter and see what it can do to get rid of the disease. 

The difficulties of handling it under present conditions have been 
well illustrated in Louisiana, California, and Minnesota, and the coun- 
try has wavered between a policy of extreme cruelty and extreme 
laxness. While some of the States insist on isolation, others, like 
Minnesota, do not, and it is needless to say that under such opposing 
policies it will always be impossible to root the disease out of the 
country. Moreover, the popular prejudice in the States against leper 
hospitals interferes with the proper enforcement of the law, of which 
we have a conspicuous example in Louisiana. The lepers, it is said, 
are willing to go into a hospital suitably located, where they will be 
well treated and get the proper medical attendance, but popular fear 
or prejudice will not tolerate a location of this kind, and it is insisted 
that the lepers be sent to some far-away point practically beyond the 
reach of those physicians who are willing to give them care and atten- 
tion. The result is that the Louisiana law requiring the confinement 
and isolation of lepers has become almost a dead letter, and only a 
fraction of these unfortunate people are confined, the greater majority 
roaming at large and thus keeping alive and perpetuating a disease 
that would soon be stamped out if the law were enforced. 

Under the present system, therefore, with one State (Minnesota) not 
properly isolating its lepers, and another State (Louisiana) isolating 
only a portion of them and allowing the others to go at large, the task 
of getting rid of this loathsome disease is difficult if not impossible, 
whereas nothing is easier than to crush it out with a little energy and 
common sense. And the fact that the United States has recently 
annexed some 75,000 or 80,000 lepers is the very best reason why 
some energy should be shown in getting rid of the malady. 

Under these circumstances, it would seem that the leper bill intro- 
duced in Congress is wholly unobjectionable, especially as its provi- 
sions are not mandatory, but simply allow the States to call on the 
Federal Government to assist them in caring for their lepers if they 
feel that they are unable to do so alone, if they can not secure a proper 
site because of the fears of the people and the objection to leper hos- 
pitals, or if the lepers are unwilling to surrender themselves and 
. accept the accommodations offered them by the States. 



LEPROSY IN THE UNITED STATES. 79 

What is wanted is the extinction of leprosy in the United States, 
and the present variegated systems in force in the several States have 
not only wholly failed to accomplish this result, but have had the con- 
trary effect. A more uniform and radical treatment of the problem 
is needed, and that the bill before Congress seems to assure. It does 
not invade the powers of the States, but merely offers the assistance 
of the National Government in the treatment of a malady which the 
States have so far been unable to handle successfully. 



[Letter from Dr. A. W. Hitt.] 

New York, September ££, 1900. 

Dear Sir: A communication from your honorable body finally 
reached me after having been forwarded to Europe and back. Before 
1 had time to answer it, was compelled to have my appendix removed, 
which caused another delay of several weeks. In the meantime } T our 
blanks were misplaced. 

With regard to lepers now under my care, will say that I have had 
none for over one year, as I have been away from home. 

Dr. S. H. Buckley brought a case to me just before I left Chicago. 
We did not tell the young lady that she had lepros}^, as her aunt 
requested us not to let her know it. Shortly after this the young 
woman and her aunt disappeared, since which time we have been 
unable to locate tbern. 

The great difficult}' in keeping a case under observation is they fear 
some measure will be taken to isolate them. This thev seem to dread 

mJ 

more than the disease. Consequently the} r disappear and go where 
the disease will not be recognized. 

I was told by the late Dr. John B. Hamilton (1897) that there were 
at that time 522 lepers in the United States. I believe you can find 
the same statement in the "Journal of the American Medical Associa- 
tion," 1897-98. 

I am pleased to hear that the lepers of the Philippines are to be 
segregated. 

While in India (1894) I made a map of that country showing approx- 
imate number of inches of rainfall during the year, also number of 
lepers in each district. 



Approximate 
average 
rainfall. 



Number of 
lepers per 
s 10,000 in- 
habitants. 



Rajputana 

Hyderabad 

Oudh 

Bombay Presidency. 
Burma 




1.4 

3.4 

3.9 

5.3 

11.8 



80 LEPROSY IN THE UNITED STATES. 

In looking for a location for these unfortunate people, it might be 
well to take the above into consideration. 

I have been very much interested in the work for about ten years, 
and it will give me pleasure to assist the leprosy commission in any 
way possible either here or elsewhere. 

Awaiting your further orders, I am, 

Yours, faithfully, 

A. W. Hitt. 
Dr. J. H. White, 

Chairman Leprosy Commission, Washington, D. C. 



[Letter from Dr. A. W. Hitt.] 

New Yoek, September 27, 1900. 

Dear Doctor: I desire to acknowledge receipt of and thank you 
for your esteemed favor of September 25. Would like to know if any 
reports in book or pamphlet form have been issued by the leprosy 
commission. 

I have a set of lantern slides which 1 made while on my last trip, 
showing the anaesthetic, tubercular, and mixed types of leprosy. Also 
a few slides showing leper asylums, "fern trees" (which grow only 
where there is much moisture in the air), manner of shaving, and 
others relating to the same subject. 

It will give me pleasure to send these to you when I return to 
Chicago, if you care to make copies of any of them. Unfortunately, 
some of my best plates were broken by Dr. Kuh, of Chicago, two 
years ago. I presume you have seen some of them, as they have been 
copied by Dr. Ashmead and others. Dr. F. G. Lydston, in his recent 
work on Genito-Urinary Diseases, is the only one, however, who has 
given me credit for any of them. If you will pardon me for taking 
up more of your time, I will give you a few notes on observations 
made while in India: 

Fish. — A fish diet (if the fish are fresh) will not affect lepers. Milk 
alone will not affect them, but a mixed diet of fish and milk will in 
many cases cause the ulcers to enlarge, and the discharge from them 
to become profuse at times. 

While I do not believe, as some do, that a fish diet will cause lep- 
rosy, will say that the rotten fish, as generally eaten by the natives of 
India and the Philippines, act as an important factor in the causation 
of the disease in districts where lepers abound. A general dermatitis 
is produced by the ingestion of decomposed fish. In this way the soil 
is prepared for the seed, and a man in this condition, if brought in con- 
tact with lepers, is more liable to take the disease than if his skin was 
in good condition. 



LEPEOSY IN THE UNITED STATES. 81 

Ulcers. — I believe it to be a great mistake to heal the ulcers by local 
applications, as is so often done. I noticed that in such cases the tem- 
perature generally went up to 101-104°, and the patient, who at first 
seemed to be doing well, suddenly passed away with diarrhea. I 
always keep the ulcers clean and depend upon other means to heal them. 

Increase. — I believe the rapidity with which the disease increased in 
the Sandwich Islands was due to the fact that the natives ate poi from 
a bowl in common. In this way the mucous membrane of the mouth 
was infected. In India the increase was due to careless vaccination. 
Now, do not understand that I am an antivaccinationist; far from it. 
At the same time I will say I am opposed to vaccination as practiced 
by men sent out by the Indian government. They vaccinate men who 
have syphilis, leprosy, and other diseases. A week later they call and 
get the " scab" from the arms of any of their previous victims, and 
use it in the next village. In this way about 6,000,000 people are 
vaccinated annually in India. All I can say is, God pity those poor 
unfortunates. 

Treatment. — To be brief: Chaulmoogra oil by inunction is good; 
internally, it is worse than nothing. Have seen them so nauseated 
after taking it that it was with difficulty I succeeded in stopping the 
terrible retching. In many cases arterial blood was brought up by the 
hard retching. Ichthyol is goo,d in large doses. I increase the dose 
gradually from 10 minims to a teaspoonful, three or four times a day, 
until I notice the ichthyolic fetor. Watch the patient carefully but 
do not be afraid of large doses. 

Bathing. — Bathing in water slightly acidulated with sulphuric acid 

I believe to be an excellent thing. Calcium iodide is another favorite, 

and my best results have been obtained by giving it and the baths. 

Of course no two cases can be treated alike. 

******* 

If a report of the work done b}^ the commission is issued in the 
future I would like to secure a copy if you can let me have it. 

Apologizing for the length of this letter and trusting that you will 
command me if I can serve you in any way, I am, 
Yours, very truly, 

A. W. Hitt. 
Dr. J. H. White, 

Chairman Leprosy Commission, Washington, D. C. 



[Letter from Dr. A. W. Hitt.] 

15 West One Hundred and Third street, 

New York, February 11, 1901. 
Dear Doctor: I am sending you by express to-day a box of lantern 
slides showing some of the Indian leper cases. Some of these slides 
apparently do not pertain to the subject. The picture of the fern 

S. Doc. 269 6 



82 LEPROSY IN THE UNITED STATES. 

tree, for instance, shows the amount of moisture in the air. After 
carefully studying the question I have noticed that wherever the ferns 
on these large trees flourish we also find a great many cases of leprosy. 
You will also observe a picture of the native barber. He uses the 
same razor to shave lepers, syphilitics, and the men who are free from 
these diseases. The razor is never cleansed further than wiping it on 
the corner of a dirty loin cloth. In this way, I believe, the disease is 
communicated to many. There is one picture of a man carrying two 
children to the village to be vaccinated. Lymph is often taken from 
the arms of lepers to vaccinate these children. * * * 

There are four pictures taken from Impy's Book on Leprosy, show- 
ing two tubercular cases before and after having taken and recovered 
from e^sipelas. * * * 

If I can serve you in any way I assure you it will give me pleasure 

to do so. 

With kind regards, I am, yours, fraternally, 

A. W. Hitt. 
Dr. J. H. White, 

Chairman Leprosy Commission, Washington, D. C 



LEPROSY. a 

By A. W. Hitt, M. D., Chicago. 

As I read a paper on leprosy before this society some time ago, 1 
will not take up much time with the history of the disease, but will 
endeavor to give you a few notes on symptoms, cause, and treatment. 
I believe that the picture presented to-night with the aid of the ster- 
eopticon will give you a better idea of the disease than anything I 
could say. 

The poor unfortunate lepers are treated as badly or even worse than 
they were two thousand years ago. Last fall one poor fellow who was 
said to be a leper was lassoed like a wild steer and tied down like a 
wild beast by the marshal of an Indiana town. 

Two years ago I was invited to attend the Ohio State Medical Asso- 
ciation, in Columbus, to examine two girls who were said to have 
leprosy. They were hauled 50 miles through the country in a wagon, 
and when they arrived the cry of "Unclean! Unclean!" was set up, 
as it was in the time of Moses. They were compelled to sleep on the 
floor of a dissecting room in a medical college. Early the next morn- 
ing they started for their home in Perry County. 

While the people hold up their hands and cry "Unclean! Unclean!" 
they are doing nothing in the way of protecting themselves by isolat- 
ing these cases. 

a Read before the Chicago Medical Society, September 29, 1897. 




ILLUSTRATING "LEONINE ASPECT." 




>^A 




LEPEOSY IN THE UNITED STATES. 83 

There are now about 530 cases of leprosy in the United States, so 
it behooves us to be a little more active in this line of work. 

Leprosy is to be found in almost every country in the world, and in 
most of these places is increasing rapidly. We have only to watch 
the daily papers and medical journals to see the truth of this assertion. 
It is demanding so much attention in Europe that it was found neces- 
sary to call a congress of leprologists to meet in Berlin during the 
coming October. 

In a dispatch from Samoa via San Francisco it is stated that — 

several lepers from the Sandwich Islands managed to reach Samoa and have spread 
the disease among the native Samoans. The natives are now trying to check the 
disease. One leper died recently, and United States Consul Churchill ordered the 
house in which the leper lived and all the surroundings to be burned. 

Leprosy was carried to the Sandwich Islands by the Chinese. 
There were doubtful cases as far back as 1818, but Dr. Hillebrand, 
who has practiced in these islands since 1851, says that the first well- 
authenticated case was reported there in 1858. As the natives had 
never heard of the disease and had no words to express it in the 
Kanaka, they called it " miapake " — or Chinese disease. It is said there 
is now one leper to every thirty, and some say one to every ten, healthy 
natives in these islands. 

In a letter to Dr. Ashmead, of New York, Dr. Mouritz, of Molokai, 
says that place — 

is one of the best fields for observing the penalty the human race is paying for its 
apathy in dealing with leprosy. The lepers at Molokai number between 11,000 and 
12,000, chiefly natives, but within a year or two the disease has begun to make 
inroads upon the white population. 

Leprosy has increased in Colombia in an alarming manner. In No- 
vember, 1890, there were about 18,000 lepers in that country. A recent 
estimate of the number of lepers there shows about 27,000 cases, or an 
increase of 9,000 or 50 per cent in seven years. 

While the reports show that leprosy is not increasing in India, I 
full}' believe that if we exclude the cases of leucoderma and s} T philis, 
which were included in the reports ten years ago by the ignorant police 
who took the census, it will be shown that there has been an increase 
of 60,000 cases up to the present time. Many other instances could 
be cited to show that the disease is increasing rapidly in different parts 
of the world. 

India has about 250,000 lepers, while China is said to have about 
the same number. British Guiana has 1,000; Trinidad, 860; Russia, 
2,000; Egypt, 2,058; Malta, 73. South Africa, Madagascar, and other 
countries have quite a large number. 

It is generally believed that only filthy people, who live huddled 
together like animals, have the disease. This is not the case, however, 
and while we admit that a majority of lepers are poor, and their sur- 



84 LEPEOSY IN THE UNITED STATES. 

roundings are far from what they should be, the physician, the priest, 
and even the king in his palace will fall a victim of the disease if 
brought in contact with it. "Pharaoh, king of Egypt, was smitten 
with leprosy," so the Talmud informs us, and when he died he was 
buried in the field of the kings and not placed in a tomb in the pyra- 
mids. The king referred to was probably Rameses IV. 

King Uzzia also had leprosy. Robert Bruce, King of Scotland, died 
of leprosy in 1392. 

Miss Mary Reed, an American missionar}^ to India, while visiting 
her parents in Ohio a few years ago, discovered that she had contracted 
the terrible disease. Mr. Thomas Jackson, who is now a leper and 
has charge of the l^per asylum in Dehra Dun, N. W. P., India, told 
me that he could not remember ever having been brought in contact 
with a leper before entering the asylum. He was for years clerk of 
one of the Indian railways, and in his work was obliged to handle 
money given in at the window by natives. 

There are two types of the disease, the anaesthetic and the tubercular, 
which, when united, form what is called the mixed type. The same 
bacillus causes both forms. I believe that the tyipe of the disease is 
determined by the channel through which the bacilli enter the body. 
Should they be deposited on the skin, especially in a weak place, and 
remain undisturbed, tubercular leprosy would be the result; while if 
the bacilli should be deposited or find their way into a wound I believe 
we would have the anaesthetic form. 

SYMPTOMS OF NERVE OR ANAESTHETIC LEPROSY. 

The first S3^mptom which attract the attention of the patient is a 
tingling or burning sensation in patches or in different parts of the 
body. The backs of the hands and the forearms are the parts thus 
attacked. Lancinating pains along the course of the nerves are next 
noticed, and the color of the integument changes. In some cases it 
becomes darker, in others the skin pigment is diminished and the part 
becomes lighter than the surrounding skin. Pemphigoid eruptions 
are commonly noticed. An erythematous rash appears over the 
affected parts. The pimples vary in size from that of a lentil to that 
of a pea. These spots spread peripherally and begin to fade first in 
the center. The patches gradually fade and the epidermis shows a 
tendency to desquamate after the drying up of the eruption. The 
complete cessation from the surfaces of these spots is looked upon by 
eastern authorities as a very important diagnostic point. Pilocarpine 
will not affect these spots, but the surrounding tissue will be covered 
with moisture. In some cases the spots are delayed and do not appear 
until the disease has been in the system for several days. Thin says: 
' ' The spots are never present on the scalp, and very rarely on the 
palms and soles." 



LEPEOSY IN THE UNITED STATES. 85 

The destruction of the nerves disturbs nutrition and the sense of 
feeling. Soon the most distressing part of the disease manifests itself, 
and the extremities and face are mutilated. The phalanges either drop 
off or become absorbed and disappear. The nose sinks in, and leaves 
a ghastly looking patient, whose face can never be forgotten. The 
fingers and toes become crooked and fixed. 

The hair drops out from the affected parts in tubercular leprosy, 
while it becomes white in the anaesthetic spots of nerve leprosy and 
does not always fall. There is a great pain about the eyes, nose, 
cheeks, mouth, and limbs. The pain is much more severe during the 
night than during the day. After months or years of suffering the 
pain ceases and anaesthesia supervenes. An eye can be cut into with- 
out hurting the patient. The patient's health fails after years of suf- 
ering, he becomes anemic, and visceral complications arise. Amyloid 
degeneration of the kidneys and liver, with chronic diarrhea, finally 
puts an end to his suffering and miserable existence. 

SYMPTOMS OF TUBERCULAR LEPROSY. 

The patients generally suffer with attacks of fever and vertigo. 
They also perspire profusely. When the disease is well advanced the 
tubercular or nodular masses on the face, with the greasy, shining 
appearance, cause the patient to look simply frightful. This is the 
leonine appearance, commonly noted by both modern and ancient 
writings. 

Thin says: 

When the parasite has established itself in the skin, the first effect, before there 
are any changes observable to the eye, is to set free a poison which produces more or 
less marked results in different individuals, causing the so-called prodromata or pre- 
monitory symptoms of leprosy. After a time the multiplication of the parasite causes 
a vasa-motor paralysis of the part in which it grows, producing the exanthem of 
tubercular leprosy. 

The further development of the bacillus leads to direct changes in the coriurn 
itself, causing swelling, thickening, infiltration, and discoloration, which vary accord- 
ing to the extent and rapidity with which it grows. This forms the so-called tuber- 
cular stage. The breaking down of connective tissue and the destruction of blood 
vessels produced by this excessive growth of bacilli lead to ulceration — the ulcerative 
stage of tubercular leprosy. Finally comes a time when, in most cases, the bacillus 
leads to leprous deposits in the liver and spleen, and the patient becomes exhausted 
from the constant discharge from the ulcers and by visceral complications, to which 
he eventually succumbs, unless in the meanwhile he has been suffocated by the lep- 
rous growth in the larynx or has died of some acute intercurrent malady. 

BACTERIOLOGY. 

The bacillus leprse has been found in almost all the tissues of the 
body in persons affected with leprosy, but it is in the cells of the dis- 
eased nerves and skin that the bacilli will be discovered in greatest 
abundance. The lepra bacillus resembles that of tuberculosis. In 
length it is about one-half to three-fourths the diameter of a human 



86 LEPEOSY IN THE UNITED STATES. 

blood corpuscle. As it has not been found free in the blood, it is 
doubtful whether it will live outside the cell wall. 

The lepra bacillus causes both forms of the disease. It is true that 
food and climate act as important factors in the cause of the disease, 
but the bacillus of leprosy is now regarded by all observers as the 
true cause. 

Dr. Jonathan Hutchinson says that a fish diet will cause leprosy. 
Bacilli leprae have not been found either in fresh fish or dried fish; 
therefore I can not believe that eating fish alone will cause the disease. 
I consider, however, that it is an important factor in the causation of 
leprosy in India, where for three months the rain falls in torrents at 
times and causes the rivers to overflow their banks and cover the land 
in all directions. When the water recedes little puddles are left in the 
roads, the fields, and even in the yards of some of the places. In 
these mud holes are hundreds of little fish. The children wade and 
catch the minnows or fish by straining the mud through their fingers. 
They are thrown into a basket and soon decompose under the tropical 
sun of India. They are made into a paste or preparation called "nga- 
pi," which is sinrpty a mass of putrid fish. Eating this paste produces 
a dermatitis, which in turn makes it easy for the bacilli to find a 
lodging place in the skin when brought in contact with it. 

I have noticed one peculiar thing in this connection. Fish, as I have 
stated, will not affect a leper, neither will milk alone; but when we 
give a mixed diet of fish and milk the ulcers enlarge and the patient 
grows worse. I do not know why this should be the case, unless it is 
because the combination in someway helps to produce better media for 
the multiplication of bacilli. Almost every article of diet used has in 
turn been unjustly accused of having caused leprosy. I believe that 
the lack of food, or anything else that has a tendency to lower vitality, 
will act as an important factor in the causation of leprosy. The 
Kabirpauthis of India, who abstain as a rule from the use of meat, 
show the largest ratio per 10,000 of any religious sect in India, while 
the Jains, who always abstain from the use of animal food, going so 
far as to tie a piece of flannel under their nostrils to prevent insects 
being inhaled and killed, show next to the smallest ratio. On the other 
hand, the Christians and Mohammedans, who eat meat and live on a 
mixed diet, show a high ratio, while the Sikhs, who also live on meat 
and a mixed diet, show the lowest of all in India, viz, 1.9 per 10,000. 
We gain nothing by classifying them according to their religious 
castes, which allow only a certain kind of diet. 

The quantity and quality of food, with unhygienic surroundings, 
help to produce the disease, as the following will show: The number 
of lepers per 10,000 in rich castes of India is 0.81; in middle castes, 
2.3; in poor castes, 3.05. 

After studying the matter carefully I have come to the conclusion 



LEPKOSY IN THE UNITED STATES. 87 

that climate plays a very important part in the causation of lepros}^. 
We find the majority of the cases in either a cold, damp climate, or a 
hot, moist climate. There has been a leper asylum in Iceland for 
over two hundred years. 

In the following table it will be seen that as the rainfall increases 
the number of lepers increases in proportionate degree. We will begin 
with the western portion of India, where the amount of rainfall is 
small, and go to the eastern part, where there is an immense rainfall. 



Rajputana (very dry) 

Hyderabad 

Oudh 

Bombay Presidency (Northern) 
Burmah 



Average 
rainfall. 



Inches. 

7 

30 

38 

74 

105 



Number of 
lepers per 
10,000 inhab- 
itants. 



1.4 
3.4 
3.9 
5.3 

11.8 



Most of the cases in the United States are to be found in the South- 
ern States and along the Pacific and Atlantic coasts. . 

I believe that a majority of leprologists hold that leprosy can be 
communicated by inoculation. I reported several cases some time ago 
in which the disease had been taken in this way. The case of Kenua, 
the condemned murderer, in the Sandwich Islands, is well known to 
most of you. I have not time to go into the case further than to say 
he was inoculated with leper tissue and lymph by Dr. Arning, and 
died from the disease about six years later. Cases of accidental inocu- 
lation could be mentioned bj> the dozen. 

In speaking of vaccination from the vesicle of a leper, Dr. Ohmann- 
Dumesnil says: "This is certain to transmit the disease in nearly 
every case." I know of several cases where children have become 
infected by being vaccinated with the lymph taken from the arms of 
lepers. 

Mr. William Tebb, in his interesting book on the recrudescence of 
leprosy, reports a case in which about 60 school children out of a class 
of 150 who were vaccinated with lymph taken from the arms of infected 
persons were attacked by leprosy. 

From 3,000,000 to 6,000,000 children are vaccinated in this way 
every year in India. Who can tell what the result will be? 

Leprosy is not a contagious disease in the ordinary sense of the 
word. It can not be contracted in the same manner as smallpox and 
yellow fever, but a person must either come in close contact with the 
infected person or something on which the bacillus has been deposited. 
Leprosy is not hereditary. There is no well-authenticated case on 
record, so far as I am aware, of a child having been born with the 
disease. 

The average life of a man suffering with the anaesthetic type of lep- 



88 LEPROSY IN THE UNITED STATES. 

rosy is about eighteen and one-half years, while in the tubercular 
type the average is about nine and one-half years. This applies to 
India. In South Africa and in cold climates the average is much 
shorter. 

SEGREGATION. 

The question is often asked how we are to get rid of the cases we 
now have. I answer that we must do as other countries have done, 
and segregate these unfortunates. In France alone, in 1226, during 
the reign of Louis VIII, there were 2,000 leper asylums, while the 
number of asylums in all of Europe was about 19,000. By closely con- 
fining their lepers these countries have almost driven the disease out 
of the land. So long as segregation was practiced they succeeded 
admirably, but when they felt safe and became apathetic it again com- 
menced to increase. 

Our next-door neighbors, Mexico, Cuba, and Venezuela, have several 
thousand cases of leprosy. Considering the rapid means of transporta- 
tion between these countries and the United States, it seems that our 
quarantine laws should be more rigidly enforced. 

As new territory is about to be annexed to the United States which 
will bring with it several thousand lepers, we, as medical men, should 
use our influence to see that these laws are enforced. 

No emigrant coming from an infected country should be allowed to 
land without first having undergone a thorough examination for leprosy 
and other infectious diseases. As the disease ma,j be in its first stages 
and hard to detect, we should demand a second thorough examination 
for leprosy before granting naturalization papers. 

The American Public Health Association, which met in Brooklyn, 

N. Y., October 22-25, 1889, passed a resolution requesting — 

quarantine commissioners of ports having connection with Cuban ports to, exercise 
the same vigilance with regard to leprosy that is already observed in the case of 
yellow fever during what is known as the quarantine period. 

Supervising Surg. Gen. John B. Hamilton, on December 23, 1889, 
issued a circular to the officers of the Marine-Hospital Service, instruct- 
ing them to detain all lepers at quarantine stations and prevent their 
landing in this country. All such cases were to be returned to the 
country whence they last sailed. This order was approved by Secretary 
of the Treasury William Windom and President Benjamin Harrison. 

In addition to the above order, the United States Government, with 
the cooperation of the States now infected, should establish a leper 
asylum or colony in a district suitable for such cases and send all 
lepers to it. 

TREATMENT. 

It would be impossible for me at this time to speak of all the drugs 
which have been used in treating leprosy. Among the natives of India 
chaulmoogra and gurgan oils seem to be the favorites. The great 



LEPROSY IIS" THE UNITED STATES. 89 

difficulty in using chaulmoogra oil is that it nauseates the patient so 
that it can not be retained and upsets the stomach so that he can retain 
nothing else. In small doses it is not so bad, but when given in doses 
large enough to be of any value as an alterative it is hard on the 
stomach. Good results are sometimes obtained from inunctions of 
chaulmoogra oil. 

Arsenic in recent cases is sometimes of service. Danielssen used 
iodide of potassium for forty years with very good success. Applica- 
tions of pyrogallol, chrysarobin, resorcin, and ichthyol have been 
highly recommended bj^ Unna. 

Surgical and other wounds of lepers generally heal rapidly. It is 
not a good idea to heal these ulcers by simple local applications of 
ointment or antiseptic dressing. Of course the ulcers should be kept 
as clean as possible, but an alterative should be given in every case 
before attempting to heal up the ulcers; otherwise the temperature of 
the patient is likely to go up to 102° or 104°. 

I prefer the iodide of calcium to the iodide of potassium, as we do 
not have the disagreeable stomach disorder following its employment 
and as it is a better tissue builder. The iodide of calcium can be given 
in four-grain doses after each meal and before retiring. It is better 
given in combination with bromide of calcium and sirup of sarsapa- 
rilla. I have found ichthyol to be a very good remedy in tubercular 
leprosy in addition to the iodide of calcium. I begin with ten-drop 
doses, which are gradually increased until a dram is taken at a dose. 
This can be kept up for some time without any toxic effects. 

Bathing is very necessaiy. In some cases it is well to put enough 
sulphuric acid in the water to make the bath slightly acid. I believe 
that separate baths should be arranged for the two types of the dis- 
ease, and that patients with the anaesthetic type should not be allowed 
to use the same baths with the tubercular cases, as this increases the 
liability of their taking on the mixed type of leprosy. 

While I have had no experience with the serum treatment, I believe 
much good may- be expected of it. I reported a case last year of a 
tubercular leper, who, after recovering from an attack of smallpox, 
found that his tubercles and every sympton of leprosy had disappeared. 
Dr. Impey, in his handbook on lepros} T , describes two cases in which 
decided improvement had taken place after an attack of erysipelas. 

A 10 per cent solution of pyrogallic acid painted over the anaesthetic 
spots often does good, and the anaesthesia disappears. In some cases 
where the ulceration is very extensive and the patient's vitality low 
it is hard to heal the ulcers. 

My experience lately has led me to believe that better results may 
be had in the treatment of these ulcers by using nosophen (tetra- 
iodophenolphtalein). It is decidedly the best antiseptic dusting powder 
I have ever used in treating ulcers of any nature. It is nontoxic and 



90 LEPEOSY IN THE UNITED STATES. 

does not irritate. To exert its antiseptic action nosophen must first be 
converted into a soluble form. Such a conversion is brought about by 
the free alkali of the human secretions, the lymph and the blood. 
The soluble sodium salt of nosophen, antinosine, is thus originated and 
has the opportunity of exerting its bactericidal properties. 

I believe that many cases of the disease can be permanently arrested 
and the mutilation, the most distressing symptoms of the disease, done 
away with. Many of these poor unfortunates can be returned to their 
families in such a condition that they will be able to support them, and 
at the same time not contaminate them. Much earnest work remains 
to be done in this line, and we can only hope to be successful by giving 
more of our time, and money if need be, to the study of this loathsome 
disease. 



[Letter from Surg. R. D. Murray, M. H. S.] 

Office of Medical Officer in Command, 

Marine-Hospital Service, 
Key West, Fla., November 15, 1900. 

Gentlemen: When I received your circular letter of February 
28, I began a paper recounting my personal experience with leprosy, 
and to collect names, residences, etc., of lepers, but when informed 
by Dr. Porter that he would send you a complete report for the State 
my interest in the matter began to lag. My favorite daughter then 
showed signs of fatal illness and my enthusiasm over things temporal 
cooled down. My child's illness has depressed me, and prevented me 
from caring for private patients — thus I have been unable to get 
points, for leprosy is a private matter in most instances, and for a 
lifetime in some. 

I write thus much to show you that I am and have been interested 
in your investigation, and in apology. 

When I first came to Key West, in 1871, I was confirmed in my 
earlier notions as to continued presence of yellow fever here, and was 
soon informed that convulsions, cancer, and infantile tetanus were 
common diseases. Consumption and malarial fever were unknown, 
but "slow fever" and " three-day fever" were alluded to familiarly. 
Under the breath it was hinted that leprosy existed here. (These 
points were given me by ex-Senator Mallory, former Confederate 
secretary of the navy.) Some talk with doctors of that day confirmed 
all that the Senator had told me except as to yellow fever; but as that 
disease was not recognizable by said doctors unless there was black 
vomit, it was fair to accept all as true. 

It was my fortune in a few years to treat the first case of tetanus in 
an adult, and the first case of infantile tetanus that up to then had 
survived the disease (both persons are now living), and to attend in 



LEPROSY IN THE UNITED STATES. 91 

due form a woman who was delivered of a boy baby. The latter job 
was a decided innovation in Key West, as for all time before women 
had cared for women in travail, and no lady would have a doctor attend 
her in childbirth. 

In 1875, following Bowditch's assumptions about undrained subsoil, 
I wrote a paper showing that consumption had not been here and 
could never exist here; alas, the northern and Cuban consumptive 
came, and, in 1885, this town was a phthisical town, and so continues. 

Cancer, "slow fever," " three-day fever," and tetanus are yet well 
known, but it is remarkable that convulsions, fits, spasms, etc., are 
rarely heard of. 

The practically constant presence of yellow fever and leprosy, and 
the impossibility of remembering the deaths, impelled me in 1874 to 
influence Hon. J. J. Philbrick (the next best friend this town ever 
had) to pass an ordinance in the city council providing for registration 
of births and deaths. I tried in the same } 7 ear to have a State board 
of health law enacted, visiting Tallahassee for the purpose, but was 
prevented from doing a good thing by some schemes of land-grabbing 
politicians. Had my hand been shown in the local bill the law would 
not have been passed, and Key West would not have the distinction 
of being the first town in Florida to have a death-certificate and burial- 
permit law. I had much trouble for two years to have the law 
respected, but, by being very courteous to Sexton McHugh, I gained 
my wishes, and the law soon got too old for anyone to think of pro- 
posing its repeal. Some of my efforts in its enforcement were amus- 
ing; one instance nearly tragical to. me. I regret to state that the 
execution of the law is not productive of the benefits I hoped for. I 
think all the leprosy death certificates recorded are signed by me. 
For family reasons doctors write pneumonia, blood poisoning, athrep- 
sia, and other obscure titles when a leper dies. 

Soon after I was stationed here, in 1872, 1 heard of Mrs. V. as having 
leprosy — the matter has affected me socially and seriously — although 
I never saw her and she is still living. During my first detail here I 
saw about twenty lepers, treated some of them, but my notes are too 
far away for me to refer to them. During my second detail, from 1888 
to 1893, 1 saw as many more, treating five of them, generally purchas- 
ing the so-called specifics myself. 

In 1890, while serving as local health officer, I had one colored woman 
returned to Nassau, the first instance here where a leper was refused a 
landing. 

In 1888 Dr. E. C. came here and busied himself so much about the 
disease as to find about 100 cases. He disputed all quarantine proced- 
ures, and in one instance got into trouble, viz: In 1873 I had told Mrs. 
H. that she had vitiligo, and would always have it. C. said she had 
leprosy, and while I was in the Manatee epidemic Mr. H. horsewhipped 



92 LEPBOSY IN THE UNITED STATES. 

hiin. Mrs. H. is living. C. went to Tampa, and in four days, in Sep- 
tember, found four lepers. Subsequently he had a column put in the 
New York Sun about the 100 lepers in Key West who were making 
the cigars for the town. At a meeting of nearly all the physicians, 
held soon after, I proposed to smoke all the cigars lepers could make, 
and found 1 knew more about the disease than the others did. In the 
talk I stated that Dr. C. was a leper. A kind newspaper published 
the last remark, and soon after Dr. C. challenged me to fight a duel. 
I declined the banter and met him afterwards socially. In 1893 he 

died in his cabin on Island, West Indies, and J and his 

two sons burned cabin, trunk, and corpse. Thus much do the people 
in the West Indies (and here) fear leprosy. 

Dr. C. claimed a former intimate acquaintance with the priest, 
Damien, who died with leprosy in Molokai a short time before, and 
published a newspaper essay in which he described four varieties, viz, 
tubercular, anaesthetic, nervous, and psychic, i. e., affecting the brain. 
I frankly admitted the existence of the fourth form, being aware of 
many (too many) who show signs of being affected by it. 

At the conference referred to I learned that the IT. boy who had 
been sent to San Diego baths in Cuba by Dr. B., and whom Dr. Bur- 
gess would not permit to return in spite of Dr. B.'s certificate of 
scrofula, etc., had actually regained his home here via New York and 
rail. The Cuban doctors talked Spanish, and I could understand 
them. 

In 1892 Dr. Porter rented a room for Henrietta Gaiter, paying $30 
per month. The State board of health objected to paying after five 
months, and she died in the poorhouse. 

I have for a long time insisted on at least registration of lepers, and 
in 1894 Dr. Porter, at my instance, had the State board of health pass 
an order for a secret register in control of the State health officer, but 
three months afterwards a member of the board forced the abroga- 
tion on the grounds that the rule was against personal liberty and 
good policy. On this, Dr. Porter proposed to resign, and I think 
would have done so but for my influence. 

Mr. T. was vaccinated in 1871 during the epidemic of smallpox. In 
1876 he had what was called writer's palsy, and began to wear gloves. 
In 1884 he knew what he suffered with, and jumped off the steamer 
Cochran in the night. His wife suffered too. I treated her until I 
went to Chandeleur. She died alone, and was dead for three days 
before the fact was known. A few years ago the wife of a prominent 
man here died with what was called blood poisoning, but the husband 
and her friends knew what she had. She had been intimate with T., 
and with his wife, up to 1886. 

In 1890 I saw G. E., age 12; had erythema nodosum; Dr. T. said 
leprosy, but treatment carried off all the nodes, and the boy returned 



LEPROSY IN THE UNITED STATES. 93 

to the street in apparent good health. He was sent away for treat- 
ment, and after much travel and expense, died in 1896. His father 
has since died by his own hand, to save time, and others of the family 
are reported to be affected. This is a sad, pitiful history. Family 
lives away from here. 

In May, 1888, 1 made diagnoses in cases of H. M., age 27, and G. F., 
age 28, seamen. M. went voluntarily to his father's house, on one of 
the Bahama Islands, and died; I treated F. off and on when he had no 
money, and in March, 1892, he died. 

K. J. married a girl some twenty years ago, and after he was sus- 
pected. He died, after she bore him two children, about twelve 
years ago. The woman remarried, and she and the two children are 
reported well. His father, age 60, is now confined to his house with 
the disease. 

L. N. suffered for years in his brother's house and died about four 
years ago. His brother and large family of children were perfectly 
clean last winter when I saw them, but the fair and bright children 
can not attend any school in town. 

* * * -3f * * * 

In 1890 a Cuban countess suffering with Morvan's disease came here 
from Habana. I assured her landlady that the woman had leprosy, 
and she declined to give her and her retinue further accommodation. 
I helped the dear lady much by cutting off the Chinese finger nails, 
against her protests. She went to Tampa and in a half year returned 
to Cuba and died with leprosy, according to Dr. Burgess. 

In March, 1900, M. S., white, age 22, called on me for treatment. 
She had lost seven first joints from her fingers, and had other signs. 
I gave a guarded prognosis, but confirming her fears, and before the 
week was out she was sent to her father's home at a distance. She 
had suffered for four years, had been treated by a doctor for two 
years, and had served in the house of a man whose wife's mother, 
Mrs. B., has the disease. I know nothing about contact, but can sur- 
mise much. 

In 1890 I made as full a report as I could to the Census Bureau, and 
soon after gave a fuller statement to ex-Passed Assistant Surgeon Arm- 
strong, who essayed to work up the subject. 

In 1876 I began to talk about a leper home, but could never get a 
chance to visit the Florida or other islands to pick out a location. 
Tortugas was utterly unfit. However, when I saw Round Island in 
1883 1 conferred with Col. William Roy, Judge William Wright, 
Captain Gibson, and others in New Orleans. We proposed to build 
the home on a cottage plan, keeping ultimate purpose in view. We 
did not receive the support expected, and all except myself soon for- 
got all about the scheme. 

Lepers should be placed in an isolated village — not an asylum, tern- 



94 LEPEOSY IN THE UNITED STATES. 

pie, or palace. Separateness and self-dependence should be assured, 
with pigs, chickens, pets, gardens, swings, and other family appur- 
tenances. 

Lepers shun people instinctively, but remain human for a long time, 
and lepers fear lepers. No leperphobe has more fear of catching tb 
disease than a leper has fear that he may transmit it. I believe evei 
one would willingly go to a village home if assured of the chance ol 
living apart from others. For the United States one home will not be 
sufficient. Louisiana alone has enough lepers to keep one set of offi- 
cials and one outfit busy. 

The disease came here earliest from the Bahama Islands, from which 
nine-tenths of the English speaking whites and negroes came. After 
1868 some cases probably came from Cuba. The cases in English 
white and black families are perhaps all known if recognizable, but 
there are hints and rumors of cases among Cubans which can not be 
verified, because Cuban doctors are noted for dodging plain issues. 
Except the countess and the U. boy, I think no others have come from 
foreign ports since Surgeon-General Hamilton's order August, 1889, 
which order made leprosy quarantinable. 

In many instances the point of origin of a case can be guessed at, 
but in some cases which I have tried to know all about I have failed 
to get a hint of contact or even association. But lepers are like rats 
and rattlesnakes — where there is one, there is or was another not far 
off. Thus where 20 are listed for the town, it would be decent and 
advisable to make provision for fort} r . And in this estimate the 
Cubans have not been carefully considered. 

I insist that it is fair to state there has been an average of one death 
a year here (from leprosy) for the past thirty years. I can count 
nearly half that number on my fingers, and I have not been here for 
one-half that period. 

It is also proper to state that several persons here are afflicted with 
vitiligo, which by some experts here is called leprosy. I know three 
persons who have only vitiligo. I do not know what that is; but these 
persons are not lepers. The white blotching of the exposed skin is 
not uncommon in mixed races on the Gulf shores and occurs in people 
in whom a mixture of race can not be proved. 

Local names for the disease here and in the Bahamas are "sun sur- 
face" (in reference to the dark blotches on the skin in the first stage), 
""laps" (a shortening of the name), and "Coco Bay" (in allusion to a 
place in the Bahamas where it was common as at Rock Sound). 

The conditions and social relations of the few unfortunates here is 
not a happy one, and of the very poor is pitiable, but the disease being 
so unpopular and so much dreaded by every one, there is and will be 
no hope of any betterment through public or private agencies. The 
afflicted worry and fret for a while when first they observe the sun 



LEPROSY IN THE UNITED STATES. 95 

surface or numb finger ends, and in time disappear from common view. 
Meantime the bacillus works its quiet, secret, and fatal doom, afflict- 
ing whom it pleases, without warning or hope of relief. 
. I should have said higher up in this random letter that for some 
years I sent to the State health officer of Florida all the newspaper 
,ippings I could find on the subject, with the hope of having him 
Establish a leper home on one of the Florida Keys. Mosquitoes and 
lack of fresh water were the only worries I ever had. Mosquitoes 
can be killed and fresh water can be made. The saving in housing 
and clothing and the comfort of the climate give the keys a big lift as 
to availability. 

I have received no information from Dr. Q. ; have received no new 
points from Dr. J.; have received some confirmations from Dr. T., 
and from Dr. B. I have received three reports and some foreign data. 

My report is lacking in positive details, but 1 think it is reasonably 
reliable. Dr. J. proposes to write to you. He promised to do so in 
May last. I now regret that I could not talk more with the neighbors 
during the summer. 

I have kept a sort of copy of my report of individual cases, and if 
you wish incidental information I will try to supply it. 1 have been 
tardy in reporting the conditions here, because I have disliked to reflect 
against a town that has not been unkind to me, but what I have written 
is true and should be known where the truth will do good in the pros- 
pect of comfort to the alread}^ afflicted and the safety and peace of 
mind of the healthy. 

Respectfully, R. D. Murray, 

Surgeon, Marine- Hospital Service. 
The Leprosy Commission, 

Washington, D. C. 



[Reprinted from public health reports, December 30, 1898.] 
REPORT ON LEPROSY IN THE HAWAIIAN ISLANDS, NOVEMBER 29, 1898. 

By Surg. D. A. Carmichael, U. S. M. H. S. a 

Origin. — A number of statements are made relative to the introduc- 
tion of leprosy into the Sandwich or Hawaiian Islands. Some contend 
that the disease was brought by the natives themselves, who are an 
offshoot of the great Polynesian race, the Mahori branch, that inhabit 
the islands that lie to the south and west. It has existed in the 
islands of Malaysia for ages, and in Java and other islands of the great 
archipelago. 

a Detailed by the President for duty at Honolulu, in accordance with the act of 
Congress approved February 15, 1893, with instructions to make a special report on 
leprosy. 



96 LEPROSY IN THE UNITED STATES. 

There is a record that in 1778 a Hawaiian chief named Kahaina vis- 
ited China, and it is also stated that there was communication between 
the natives and those inhabiting other islands in Polynesia as far back 
as the twelfth century. In 1798 the North Pacific whaling fleet began 
to visit the Sandwich Islands, and in subsequent years made Lahaina, 
on the island of Maui, and Honolulu, or Oahu, their principal ports 
of call, and it is claimed that leprosy was brought here by the mixed 
crews — negroes, black and white Portuguese, and Chinese — of the 
whalers. In 1810 the Hawaiians began to export sandalwood to 
Chinese ports in foreign-built vessels. 

In a report made to the Hawaiian board of health in 1886 by Dr. 

Arthur Moritz, the physician in charge of the leper settlement on 

Molokai, it is stated that one of the earlier missionaries in Honolulu, 

who came to the Hawaiian Islands in April, 1823, the Rev. Charles S. 

Stewart, recorded in his diary a few weeks after his arrival: 

Not to mention the frequent and hideous mark of a scourge which more clearly 
than any other proclaims the curse of a God of purity, and which, while it annually 
consigns hundreds of this people to the tomb, converts thousands while living into 
walking sepulchers, the inhabitants generally are subject to many disorders of the 
skin, and the majority are more or less disfigured by eruptions and sores, and many 
of them are as unsightly as lepers. 

On July 4 of the same year the same observer notes : 

Indeed, we seldom walk out without meeting many whose appearance of misery 
and disease is appalling, and some so remediless and disgusting that we are compelled 
to close our eyes against a sight that fills us with horror. Cases of ophthalmic scrofula 
and elephantiasis are very common. 

The Rev. W. P. Alexander, who came here in 1833, states that the 
first case of leprosy that he saw on the islands was in a native Hawaiian 
on the island of Maui, and that he had heard several years before that 
a chief tess in Lahaina, on the same island, was affected with the disease. 

Mr. Brickwood, a resident of these islands in 1840, and who had been 
familiar with the appearance of leprosy in Egypt, recognized the dis- 
ease in a native of Honolulu. 

In Dr. Alonzo Chapin's description of the islands, published in the 
American Journal of the Medical Sciences, in July, 1838, is the 
following: 

Foul ulcers of many years' standing, both indolent and phagedenic, everywhere 
abound, and visages horribly deformed, eyes rendered blind, noses entirely destroyed, 
mouths monstrously drawn aside from their natural positions, ulcerating palates, 
and almost useless arms and legs mark most clearly the state and progress of the 
disease among that injured and helpless people. 

The descriptions given by the Rev. Mr. Stewart and Dr. Chapin 
were intended to describe the ravages of sj^philis, which had been 
introduced among the natives by the white sailors who first visited 
these islands, but the pictures presented might with equal force apply 
to lepros}^, foul ulcers of many years' standing being common in ulcer- 
ating tubercular leprosy, and the distorted visages and useless arms 



LEPROSY IN THE UNITED STATES. 97 

and legs being common in the anaesthetic type of the disease. Accord- 
ing to Dr. Hillebrand, leprosy was introduced into Honolulu by the 
Chinese in 1848, and he claims to have seen the first Hawaiian leper 
Hye 3 r ears later; ten } 7 ears later the disease had spread considerably in 
the immediate neighborhood of this case, and it is possible that the 
Chinese carried the disease to other points in the islands. 

^Mr. R. W. Meyer, for many years agent of the Hawaiian board of 
health at the leper settlement on Molokai, in his report for 1886 states 
that he arrived at the islands in 1850, that in 185 T he first heard of the 
appearance of leprosy among the natives, and that in 1859 or 1860 he 
saw the first case of .leprosy in a young native who died with it in less 
than three years. The young man's mother took care of him, and, 
probably in 1868, she showed signs of leprosy and died a leper at the 
settlement. The Chinese generally get the credit for its introduction, 
although this is denied by- many observers, and it is a singular fact 
that few Chinese on these islands have the disease in comparison with 
the large number of cases which have occurred among the native 
Hawaiian s. 

Restrictive measures. — A board of health was first organized on 
December 11, 1850, by the order of King Kamehameha III, to aid in 
the preservation of the public health and for the cure of contagious, 
epidemic, and other diseases, and more especially cholera. Until the 
close of 1863 and the beginning of 1861 no measures were taken by 
the Kingdom of Hawaii for the suppression of leprosy. At the begin- 
ning of 1861 the spread of the disease in Honolulu and other places in 
the islands had awakened public apprehension, and in 1865 the legis- 
lature of the Kingdom of Hawaii enacted a law to prevent its spread. 
The act is here quoted in full in order to show the authority relative 
to segregation conferred by it. 

AN ACT to prevent the spread of leprosy, 1865. 

Whereas the disease of leprosy has spread to considerable extent among the people, 
and the spread thereof has excited well-grounded alarms ; and whereas, further, some 
doubts have been expressed regarding the powers of the board of health in the 
premises, notwithstanding section 302 of the civil code; and whereas, in the opinion 
of the assembly, section 302 is properly applicable to the treatment of persons afflicted 
with leprosy; yet, for greater certainty and for the sure protection of the people, 

Be it enacted by the King and the Legislative Assembly of the Hawaiian Islands in the 
Legislature of the Kingdom assembled: 

Section I. The minister of the interior, as president of the board of health, is 
hereby expressly authorized, with the approval of the said board, to reserve and set 
apart any land, or portion of land, now owned by the Government, for a site or sites 
of an establishment or establishments to secure the isolation and seclusion of such 
leprous persons as in the opinion of the board of health or its agents may, by being 
at large, cause the spread of leprosy. 

Sec. II. The minister of the interior, as president of the board of health, and act- 
ing with the approval of the said board, may acquire, for the purpose stated in the 
preceding section, by purchase or exchange, any piece or pieces, parcel or parcels of 
land, which may seem better adapted to the use of lepers than any land owned by 
the Government. 

S. Doc. 269 7 



98 LEPROSY IN THE UNITED STATES. 

Sec. III. The board of health or its agents are authorized and empowered to cause 
to be confined in some place or places for that purpose provided all leprous patients 
who shall be deemed capable of spreading the disease of leprosy, and it shall be the 
duty of every police or district justice when properly applied to for that purpose by 
the board of health or its agents to cause to be arrested and delivered to the board 
of health or its agents any person alleged to be a leper, within the jurisdiction of 
such police or district justice, and it shall be the duty of the marshal of the Hawaiian 
Islands and his deputies, and of the police officers, to assist in securing the convey- 
ance of any person so arrested to such place, as the board of health or its agents may 
direct, in order that such person may be subjected to medical inspection, and there- 
after to assist in removing such person to a place of treatment, or isolation, if so 
required by the agents of the board of health. 

Sec IV. The board of health is authorized to make such arrangements for the 
establishment of a hospital where leprous patients, in the incipient stages, may be 
treated in order to attempt a cure, and the said board and its agents shall have full 
power to discharge all such patients as it shall deem cured, and to send to a place of 
isolation, contemplated in Sections I and II of this act, all such patients as shall be 
considered incurable or capable of spreading the disease of leprosy. 

Sec V. The board of health or its agents may require from patients such reason- 
able amount of labor as may be approved of by the attending physicians, and may 
further make and publish such rules and regulations as by said board may be con- 
sidered adapted to the condition of lepers, which said rules and regulations shall be 
published and enforced as in sections 284 and 285 of the civil code provided. 

Sec VI. The property of all persons committed to the care of the board of health 
for the reasons above stated shall be liable for the expenses attending their confine- 
ment, and the attorney-general shall institute suits for the recovery of the same when 
requested to do so by the president of the board of health. 

Sec VII. The board of health, while keeping an accurate and detailed account of 
all sums of money expended by them out of any appropriations which maybe made 
by the legislature, shall keep the amounts of sums expended for the leprosy distinct 
from the general account. And the said board shall report to the legislature at each 
of its regular sessions the said expenditure in detail, together with such information 
regarding the disease of leprosy, as well as the public health generally, as it may 
deem to be of interest to the public. 

Approved this 3d day of January, 1865. Kamehameha. 

Station at Kalihi. — On November 13, 1865, a hospital with suitable 
buildings was established and opened at Kalihikai, on the island of 
Oahu, and distant from Honolulu about 3 miles. This station was 
designed for the reception, inspection, and treatment of persons 
afflicted with leprosy. Mild cases, after the diagnosis had been made, 
were to be treated here, and the more severe or incurable cases were 
to be transferred to the site recently purchased at Kalawao, on the 
island of Molokai. On the opening day 62 persons were present for 
examination, and inspection found among this number 13 lepers. In 
1866, according to the reports furnished the Government, the number 
of lepers on the different islands of the group was as follows: 

Hawaii 75 

Maui, Molokai, and Lauai 112 

Oahu 80 

Kauai and Mihau 7 

Total 274 



LEPEOSY IN THE UNITED STATES. 99 

This hospital was maintained until 1875, when it was abolished and 
a house in town on Nunanu street substituted. During its existence 
about 10 lepers died there, some 10 deserted, and many passed through 
its portals to the leper settlement on Molokai. 

There was no marked change in the condition of affairs for some 
years. The system of mild segregation was kept up, and the number of 
lepers examined and sent to Molokai varied from year to year. There 
was a marked increase in the number sent to the settlement in the 
years 1869, 1871* 1873, 1875, and 1878. In 1881 the receiving station 
for lepers, as it was then called, was removed to Kakaako, a suburb a 
mile to the southwest of Honolulu. On November 5, 1885, the Queen 
Kapiolani Home was opened, near the receiving station, for the recep- 
tion of nonleprous female children of leprous parents. In 1889 the 
receiving station was once more removed to its present situation and 
not far from its original site in 1865, at Kalihi, called Kalihi-Punhale. 
Up to 1887 all lepers and suspects examined at the receiving station 
were passed upon b} 7 one physician, but in that} T ear a medical board of 
three was appointed. All of the suspects reported to the board of health 
were taken to this station from the different islands in the group and 
examined by the board. At the present time there are six physi- 
cians on this board, and each is required to record his individual diag- 
nosis, and all must agree before a suspect is consigned to Molokai. 
This station now comprises buildings for the reception of suspects and 
treatment of lepers, offices, dispensary, bacteriological laboratory for 
the special stud} 7 of leprosy and other contagious diseases, and on the 
west side of the reservation, some distance from the other buildings 
and isolated by high palings, is the Queen Kapiolani Home for female 
nonleprous children born of leprous parents, which is under the charge 
of the Sisters of Charity. All of the scientific examinations of lepers 
and much of the experimental treatment is performed at this station, 
and is under the immediate charge of Dr. L. F. Alvarez, who has an 
international reputation as a skilled leprologist. 

Leper settlement on Molokai. — In September, 1865, the spit of land 
on the northern or windward side of the island of Molokai was chosen 
as a suitable site for the establishment of a settlement for the segrega- 
tion of lepers. The site is probably one of the most suitable and 
isolated that could have been chosen for such a purpose. It is sur- 
rounded on the north, east, and west by the sea, and the base or south- 
ern side is placed beneath a steep pali or precipice from 1,800 to 2,000 
feet high, which discourages communication with the rest of the island. 
Near the center of this tongue of land is the extinct crater of Kahukoo, 
493 feet above the sea level, which, when active, formed with the erosion 
from the .adjacent mountains and valleys the plain on which the settle- 
ment is now located. This plain has an area of about 8 square miles, 
and its breadth at the base where it joins the mountain chain is 2f 
miles, at the center 2^ miles, and seaward or northward about 1 mile. 



100 LEPROSY IN THE UNITED STATES. 

The soil is composed of lava rock, disintegrated lava, and ocean sand, 
and with abundance of water is, like most soils of volcanic origin, 
ven^ fertile. 

The first settlement was at Kalawao, on the eastern side of the spit of 
land. It lies close to the mountains at the rear and is much exposed 
to the northeast trade winds. Kalaupapa, the more recent and larger 
settlement, is situated on the plain to the westward, is further removed 
from the steep cliffs, and is somewhat protected from northeast winds 
by the crater of Kahukoo. The shore on the eastward is rugged and 
difficult of access. On the westward it is easier of approach and has 
more shelter. One and three-quarters miles seaward of Kalaupapa is 
the small village of Iloki, and midwa}^ between Kalaupapa and Kala- 
wao, and close in to the base of the mountain, is the village of Maka- 
naupapa, both included in the leper settlement. No trees grew origi- 
nally on the plain and only coarse grass on the Kalaupapa side, but 
efforts have been made from time to time to plant different varieties, 
and some success has been obtained. 

The mountain range which shuts off the settlement on the island side 
is bold and rugged and is continued east and west the whole length 
of the island, reaching toward the eastward an elevation of 3,000 or 
4,000 feet. Adjoining the settlement are the vallej^s of Waikolu and 
Waihauau. Water is supplied from the Waikolu Valley and piped 
from thence to the settlements. Storage reservoirs are placed at dif- 
ferent points as a reserve in case of accident to the main supply. As 
already noted, the site was chosen in 1865, and the settlement was 
opened for the reception of lepers in the following }^ear. The first 
establishment was at Kalawao, and here the hospital, different churches, 
and the Baldwin Home for leprous boys are located. 

When the board of health first opened the settlement, and for many 
years afterwards, much difficulty was experienced from the presence 
of persons who owned parcels of land in this tract and who were called 
Kamainas or old settlers. They were not subject to the laws govern- 
ing lepers, and were free to come and go from the settlement at will. 
Their influence was detrimental to the discipline of the place, and 
association between them and the lepers was a weak spot in the system 
of segregation. Communication with other parts of the island was 
maintained by climbing the steep trails which led up the pali at the 
rear of the settlement. 

The Hawaiian government has secured the property owned by those 
Kamainas, and they have been removed from the settlement. Molokai 
is probably the most complete settlement of its kind in the world. It 
has hospitals, churches, homes for leprous children, male and female, 
stores, market dispensaries, cottages for leper residents, jail, store- 
houses, etc. The majority of the lepers live in cottages built by them- 
selves or by the government, and in the settlement there is a total of 
all buildings of 716. 



LEPROSY IN THE UNITED STATES. 



101 



The lepers are supplied with a liberal ration by the Government, 
which for one week comprises the following: Beef, 7 pounds; salmon, 
5 pounds; fresh fish, 7 pounds; pai-ai, 1 bundle, 21 pounds net (a 
native food prepared from the root of the colocasia esculenta, often 
written "poi"); rice 9 pounds, with 1 pound of sugar; bread, 8£ 
pounds, with 1 pound of sugar; flour, 12 pounds, with one pound of 
sugar. 

Children born at the settlement of leprous parents receive one- half 
of the above ration. 

Monthly rations are also issued of soap, salt, matches, and kerosene 
oil. Each leper outside the homes receives a clothes-ration order of 
the value of $5 every six months, on the 1st of January and July in 
each year. Many of the lepers have friends outside who supply them 
with clothes and money. The Bishop Home for leprous girls and the 
Baldwin Home for leprous boys draw their supplies of food directly 
through the board of health as required. 

The cost of the settlement to the Government is about $67,000 per 
year, and the amount expended for segregation and transportation of 
lepers and maintenance of the receiving station at Kalihi amounts to 
about $16,610 per annum. 

The following table, showing the number of lepers at the settlement 
on Molokai, mortality, and the number on the books at the end of each 
year and estimated from the report of the board of health for the 
biennial period ended December 31, 1897, is given below: 



Year. 


Admissions. 


Deaths. 


Discharged 

or unac- 
counted for. 


Number on 
the books 
Decem- 
ber 31. 


1864* 


141 

70 
115 
126 

57 
183 
105 
487 

91 
212 

96 
163 
239 
125 

51 
232 

71 
301 
108 
103 

43 
220 
579 
308 
202 
143 
109 
211 
128 
106 
146 
124 


26 
25 
28 
59 
58 
51 
64 
156 
161 
163 
122 
129 
147 
209 
152 
132 
121 
150 
168 
142 
100 
108 
212 
149 
158 
212 
137 
151 
155 
128 
116 
139 


10 
7 
2 

11 
4 
9 
4 

21 
8 

14 
3 
1 


105 


1867 


143 


1868 


228 


1869 


284 


1870 


279 


1871 


402 


1872 


439 


1873 ; 


749 


1874 


671 


1875 


706 


1876 


677 


1877 


710 


1878 


802 


1879 


1 
10 


717 


1880 


606 


1881 


706 


1882 


6 
15 

8 
26 

8 

4 
28 

7 
18 

2 
19 


649 


1883 


785 


1884 


717 


1885 


655 


1886 


590 


1887 


698 


1888 


1,035 
1 187 


1889 


1890 


1 213 


1891 


1 142 


1892 


1,095 
1,155 
1,124 
1,087 
1 115 


1893 


1894 


3 

15 

2 


1895 


1896 


1897 


1 100 









a Settlement opened. 



102 



LEPEOSY IN THE UNITED STATES. 



The following table, taken from the report of Dr. A. Moritz for 
1866, shows the nationality, number, and sex received annually: 

Table showing the nationality, number, and sex of lepers received annually at Molokai from 

1866 'to 1885. 



Year. 


Hawaiian. 


Mixed. 
Hawaiian. 


White. 


Chinese. 


Other na- 
tionalities. 


Total. 




M. 


F. 


M. 


F. 


' M. 


F. 


M. 


F. 


M. 


F. 




1866 


101 
56 
72 
73 
31 

125 
69 

289 
51 

121 
55 

107 

134 
79 
31 

151 
49 

181 
60 
68 


38 
12 
37 
53 
26 
55 
36 

191 
37 
82 
39 
53 

101 
42 
17 
76 
18 

116 
37 
28 










2 








141 


1867 






1 
1 








al 


70 


1868 


2 


2 




i 






115 


1869 : 








126 


1870 


















57 


1871 


3 
















183 


1872 
















105 


1873 


2 
1 
2 
1 
2 
1 
1 
2 
2 
1 
3 
3 
2 


1 
1 
2 






3 




n 




487 


1874 


1 
3 
1 




91 


1875 




1 




«i 




212 


1876 


96 


1877 




1 








163 


1878 


2 
1 


1 
1 
1 
2 
1 










239 


1879 




1 






* 


125 


1880 








• 51 


1881 




1 

2 
1 

6 
3 








232 


1882 








71 


1883 








301 


1884 




2 
1 






<*i 




108 


1885 


102 












Total 


1,903 


1,094 


28 


9 


16 




22 




3 


1 


3,075 





a Roratongan. 



t> Mauritius. 



c Manila. 



d Lascar. 



The following table shows the number of persons sent to the Kalihi 
receiving station from the different Hawaiian islands for examination, 
and their pronounced condition, for the two years ended December 31, 
1897; also the number sent to the leper settlement in the same period: 

Examined during period 1895 to 1897. 



From island of— 


Lepers. 


Suspicious. 


Not 
lepers. 


Total. 


Oahu 


71 
100 
40 
10 
29 
19 


50 
5 

14 
1 
2 


20 
2 
3 

2 
2 


141 


Hawaii 


107 


Maui 


57 


Molokai 


13 


Kauai 


33 


At Kalihi, Dec. 31, 1895 


19 










Total 


269 


72 


29 


370 







Sent to leper settlement during period 1895 to 1897. 



Males . . 

Females 



165 
91 



Total 



256 



NATIONALITIES. 



Hawaiian.. 
Half-caste . 
Chinese ... 
Portuguese. 
German . . . 



225 

15 

9 

2 

2 



LEPROSY IN THE UNITED STATES. 103 

American 1 

British 1 

South Sea Islander 1 

Total 256 

Escaped from Kalihi 3 

Sent to Japan 3 

In Kalihi at this date 7 

Total 269 

Age of lepers sent during period December 31, 1895, to 1897. 

Under 10 years - 10 

Ten to 20 years 92 

Twenty to 30 years 51 

Visit to Molohai. — On November 1. through the courtesy of the Hon. 
W. O. Smith, attorney-general and president of the board of health, I 
accompanied the board on its semiannual visit to the leper settlement. 
The steamer Jlezama of the Interisland Steamship Company, which 
was chartered for the purpose, left Honolulu at 9.30 p. m. on the 11th 
and arrived at Kalaupapa at daylight next morning. A number of 
natives who were going to visit relatives at the settlement, by the per- 
mission of the board of health, were also on the steamer. The bold 
cliffs of the mountain range on Molokai stand out in severe lines as 
the steamer approaches, and nestling at the foot of the mountains on 
the spit of land is seen the leper settlement. 

At a distance Kalaupapa looks like a prosperous little town, and in 
anticipation of the visit of the board of health a large number of the 
inhabitants had gathered at the landing place, some on foot and many 
mounted on horses. Some difficulty was experienced in landing, 
which is done b}^ open boat, there being no docks or wharves, as there 
was a long northerly swell and the surf was somewhat dangerous. In 
the hands of natives skilled in surf boating this was soon accomplished 
without accident, and the entire party landed. After passing through 
the large crowd of lepers at the landing, and being warmly welcomed 
by a band of music composed of leper boys, we first visited the build- 
ing set apart for the use of the board of health. Here different com- 
mittees were organized for business and professional purposes. 
Headed by Dr. S. F. Alvarez a number of the medical men who accom- 
panied the party secured horses and rode across to the old settlement 
of Kalawao, on the eastern side of the leper peninsula. Here were seen 
the different churches — Protestant, Catholic, and Mormon — including 
that built by Father Damien, and the grave of this leper martyr by 
the church side. The Baldwin Home for Leprous Boys was then vis- 
ited, and the hospitals and cottages for the accommodation of lepers 
in various stages of the disease. The buildings are arranged around 
an open court in the form of a quadrangle, and the well-kept lawn, 
trees, and shrubbery make the place present quite a pleasing aspect. 



104 



LEPEOSY IN THE UNITED STATES. 



The buildings are very neat and clean, everything was found in good 
order, and the management of Messrs. Dutton and Van Lil was much 
praised. 

Many cases of leprosy were seen here, from the slight ansesthetic 
form affecting the ulnar and facial nerves to the most revolting types 
of ulcerating tubercular leprosy, and those who were sightless, para- 
lyzed, bedridden, and almost moribund. Attached to the Baldwin 
Home is a system of baths which have rendered efficient service. Our 
time being limited, we returned to Kalaupapa, and after lunch, pro- 
vided by the board and taken ashore from the steamer, the medical 
experts of the board, Drs. Wood, Emerson, Alvarez, and Myers, con- 
ducted an examination of a number of persons at the settlement. Some 
of these claimed that the disease had disappeared, and wished to return 
to their homes. A few children born in the settlement were also 
examined, and a number of kokaus, or helpers, who had resided at the 
settlement for years, and wished to know if they had contracted the 
disease. The clinic was very interesting, and many of the milder 
types of the disease were seen. In case of doubt the patient was 
ordered to the receiving station at Kalihi, near Honolulu, for further 
examination. The Bishop Home for Leprous Girls was then visited, 
and further examinations made here of a similar character to the 
others. The board having completed its business, the part} r boarded 
the steamer and returned to Honolulu. 

Spread of the disease. — From 1849 to 1865 no measures were adopted 
by the Hawaiian authorities for the suppression of leprosy. The inti- 
mate living habits of the natives, using the same sleeping mats, cloth 
ing, pipes, eating from the same dishes, bad hygienic surroundings, 
and, above all, a tolerance of the leper — that is, he was treated as a 
member of the famity, and never as an outcast — are given as some of 
the causes aiding in its spread. 

In 1852-53 an epidemic of smallpox invaded the Hawaiian Islands, 
and over 5,000 died. Vaccination of the people resorted to during 
and subsequent to this epidemic is said to have aided in the dissemina- 
tion of leprosy. The vaccinations, according to competent observers, 
were made from arm to arm, with humanized virus, and frequently the 
pulverized scab selected without much care. The vaccinations were 
done by planters, missionaries, and the natives, owing to the limited 
number of physicians available. The general opinion among leprolo- 
gists is that vaccination had little to do with the spread of leprosy; 
that the disease was not common in those years, and that there was no 
marked increase in the number of cases, within the usual period of 
incubation, subsequent to the epidemic of smallpox. 

During the residence of Dr. E. Arning here as a specialist to inves- 
tigate leprosy for the Hawaiian Government an interesting experiment 
bearing on this subject was performed by him. 



LEPROSY IN THE UNITED STATES. 105 

In 1885 he vaccinated a number of lepers. The vaccination took 
in 3 cases, 1 tubercular and 2 anaesthetic. Both the lymph and crust 
of the tubercular case contained the bacillus of leprosy, but he could 
not detect it in the anaesthetic cases. Nonhumanized virus has been 
used in the islands since 1888, and precludes the possibility of trans- 
mitting leprosy by vaccination. 

During his residence here Dr. Arning also performed his now cele- 
brated experiment bearing on the direct inoculation of leprosy. By 
consent of the Government and a condemned criminal named Kenan, 
whose sentence was commuted to imprisonment for life, Dr. Arning, 
on September 30, 1884, excised a leprous tubercle from the arm of a 
pronounced leper and transplanted it to the exterior surface of the 
left forearm of Kenan. He was confined and kept under daily obser- 
vation for the four weeks following, and after that, once a week for 
several months, a microscopic examination of the inoculation spot 
being made each time. After this he was examined regularly once or 
twice a month. The microscope revealed the presence of the bacillus 
leprae in large numbers until the middle of March, 1885. They then 
diminished in numbers, but were present in the scab fourteen months 
after inoculation. At this time there was nothing in his appearance 
indicative of leprosy. Pains in the elbow and wrist of the inoculated 
arm, which existed in 1885, four and five months after inoculation, 
soon disappeared. There was no marked change in the condition of 
Kenan until March, 1887 (two and a half years after inoculation). 
Dr. Brodie, the prison physician, then noticed changes in the right 
ear and coppery-looking spots on the right cheek. In December, 
1887, he was examined by Dr. Arthur Moritz, and his description 
given as follows: 

General health good; no pain; slight unhealthy wound on palmar aspect of left 
index finger is the only abrasion of the skin. Covering the chest, arms, abdomen, 
and especially the back, is a copper-colored eruption raised above the surrounding 
skin and giving to the touch a distinct feeling of thickening. The size of the spots 
vary from a 10-cent piece to half a dollar, and present shapes round, oval, and 
serpiginous. The backs of the legs and thighs are affected, and on the front of the 
knees and thighs are serpiginous patches and small placques. The right cheek, 
forehead, and right ear are infiltered with leprous deposit. Eyebrows show no sign 
of diminution. The ulnar and external popliteal nerves are thickened. Kenan was 
afterwards removed to Molokai, and died there. This experiment of Dr. Arning 
was widely accepted as proof of the inoculability of leprosy, but Mr. K. W. Meyer, 
for many years superintendent of the settlement at Molokai, states that there were 
lepers in Kenan's family. His mother-in-law, Pulu, died of leprosy in July, 1891, and 
Kenan's own son, Josepha, was at the leper settlement long before Kenan himself 
became a leper, and died there in December, 1895. Kenan's nephew, David, a son 
of Kenan's sister, also died of leprosy at the settlement in July, 1890. 

Other modes of communication. — Kissing, nose rubbing, cohabita- 
tion, reception of the secretions from lepers on abrasions of the surface 
of the skin or by inhalation, deglutition, or transmission by insects. 
In many of the tubercular cases and some of the anaesthetic variety, 



106 LEPKOSY IN THE UNITED STATES. 

the lips, cheeks, tongue, arches of the palate, and nose are the seat of 
numerous leprous ulcers, and it is claimed that they also exist in the 
intestines. The bacilli are readily given off from these ulcers, and it 
is said can be communicated when a suitable soil is presented, such as 
abrasions of the skin and mucous membrane, catarrhal conditions, etc. 
The natives eat poi, or pai-ai, from the same dish with the lingers, 
and a leper in the circle with digital leprous ulcers might convey it to 
others. 

The opinion prevails in Hawaii that the disease is not communicated 
by cohabitation with lepers, but leprologists admit that in the early 
stages of the disease, when it is not well denned on the surface of the 
body, leprous patches may be present on the genitals, and given an 
abrasion or suitable soil it is reasonable to infer that transmission in 
this manner is not impossible. 

It is suspected that certain insects play a part in the transmission of 
leprosy, the common house fly, mosquito, and bedbug being the prin- 
cipal carriers of the infection. The house fly is now prominent as a 
disseminator of typhoid fever and septic affections, and it is not diffi- 
cult to imagine that an active part can be taken by this insect in the 
spread of leprosy, particularly where they can pass from open leprous 
ulcers to other individuals who may present a suitable soil for the 
reception of the bacillus. I am not aware that any bacteriological 
investigations have been made in this manner relative to the house fly. 
The mosquito is also considered as the disseminator of certain diseases, 
and some light has been thrown on the influence it may have on the 
transmission of leprosy by Dr. L. F. Alvarez, the leprologist of the 
Hawaiian government. He allowed mosquitoes to alight on the open 
sores of lepers, and when they had feasted themselves they were cap- 
tured and killed, and stained preparations made from their crushed 
bodies contained leprous bacilli in large numbers. Mosquitoes are 
present in the Hawaiian Islands throughout the entire year. Until 
the life history of the bacillus leprae is worked out and isolated cultures 
obtained, the powers of resistance of the organism to external agencies 
will remain unknown, but it is believed to be very resistant, and it 
may exist in a spore condition in the soil, on clothing or other fomites, 
and on the surface of various articles. 

In 1884 Dr. Arning made some experiments relative to the resisting 
powers of the bacillus of leprosy- 
Leprous tissue and matter were set aside under conditions of temperature and 
moisture conducive to thorough putrefaction, while the growth of the larger fungi 
was carefully excluded. Microscopical examinations were made from time to time 
and the bacillus leprae was found to hold its own against the germs of. dissolution 
and putrefaction of albuminous matter and was met with so abundantly and so laden 
with spores that the idea of actual increase suggested itself to him. Subsequent exami- 
nations showed that every vestige of the cellular and fibrous structure of the tissue 
had disappeared, even the bacteria of putrefaction had crumbled up into a mass of 
detritus, but the bacillus laprse was there with all its peculiar microchemical reactions. 



LEPROSY IN THE UNITED STATES. 107 

Prompted by this investigation the same observer went to Molokai 
and procured parts of a case of tubercular leprosy which had been 
buried three months and was in an advanced state of putrefaction. In 
this tissue the leprous bacilli were present in large numbers. Dr. 
L. F. Alvarez has lately made some interesting experiments bearing on 
the possible culture of the bacillus of leprosy. Up to the present 
bacteriologists taught that the bacilli of leprosy could be distinguished 
from many other bacilli by the fact that they were not decolorized by 
strong solutions of the mineral acids. 

After many experiments he succeeded in demonstrating the existence 
of leprous bacilli, which are entirely decolorized when washed in solu- 
tions of 25 per cent of sulphuric or in 30 per cent of nitric acids. He 
states that he has never found the decolorized bacilli in old tubercles 
or ulcerating surfaces. The} 7 are found only in recent eruptions or 
new nodules, and are probably the young or active bacilli, while the 
bacilli which hold the stain are probably old and inert. He states 
that this discovery ma} 7 serve to explain the many failures in produc- 
ing pure cultures in artificial media. If the tubes are inoculated from 
old tubercles failure results, as the bacilli are dead or have lost their 
power of reproduction, and if he found colonies of bacilli in his tubes 
which did not stain he would probably throw them away. He also 
states that be has lately obtained growths of bacilli resembling those 
of leprosy in blood serum. They are decolorized by mineral acids, 
and the growth is almost invisible. The only sign of growth is a 
glazed appearance of the surface inoculated. The} 7 appear to grow 
only on the surface of the serum and do not form colonies. A mon- 
goose inoculated with these bacilli showed slight paralysis of the hind 
legs and died in a few days, but the examination did not reveal the 
cause of death. 

Immunity. — All persons are not susceptible to leprosy, and most of 
the white race seem to have a certain immunity; and if the disease can 
not be conveyed by cohabitation the white sailor seems secure. Many 
women have lived in intimate relation with leprous husbands, and 
husbands with leprous wives, and failed to contract the disease. A 
number of the kokuas, or helpers, on Molokai have lived among and 
associated with lepers for years and escaped. 

Bearing on this question, Dr. A. Moritz gives the following: 

The washerwoman for the hospital at Kalawao has washed the soiled clothes of 
lepers, the worst cases, for seventeen years; she had lepers living in her house, and 
her two husbands were lepers for years before they died, and yet in spite of all this 
contact this woman is hale, hearty, and plump, and as fine a specimen of woman- 
hood as any in the islands. 

Such cases must possess a certain immunity which is wanting in 
others. 

The native Hawaiian seems more susceptible to the disease than any 
other race at present on the islands, and a glance at the statistical tables 
already given will confirm this statement. 



108 



LEPROSY IN THE UNITED STATES. 



The population of the Hawaiian Islands, as given February 8, 1897, 
was as follows: 



Nationality. 



Hawaiian 

Part-Hawaiian 

American 

British 

German 

French 

Norwegian 

Portuguese 

Japanese ' 

Chinese 

South Sea Islanders 
Other nationalities . 

Total 



Males. 


Females. 


16, 399 


14, 620 


4,249 


4,236 


1,975 


1,111 


1,406 


844 


866 


566 


56 


45 


216 


162 


8,202 


6,989 


19, 212 


5,195 


19, 167 


2,449 


321 


134 


448 


152 


72, 517 


36, 503 



Total. 



31, 019 

8,485 

3,086 

2,250 

1,432 

101 

378 

15, 191 

24,407 

21, 616 

455 

600 



109, 020 



The present census of the leper settlement on Molokai, taken on 
November 11, 1898, is as follows: 

Leper males, 634; leper females, 439; total, 1,073. Detail, Baldwin 
Home, boys, 141; detail, Bishop Home, girls, 130. Nonleprous chil- 
dren of leprous parents, male, 43; nonleprous children of leprous 
parents, female, 18; total, 61. Helpers (kokuas), nonleprous persons 
permitted by the board of health to live in the settlement and care for 
leprous relatives, etc., males, 37; females, 36; total, 73. Nonleprous 
priests, sisters, brothers, teachers, etc., 61; total of all persons at the 
settlement November 11, 1898, 1,207. 

Heredity, — At onetime much importance was attached to the theory 
of heredity in this place, but in the light of the present day it is con- 
sidered an exploded theory. A person has only to visit the Kapiolani 
Home at Kilihi and see the healthy female children born in the settle- 
ment of leprous parents (one or both lepers) and ranging in age from 
3 to 20 years, to be convinced that there is little in the theory of 
heredity. In contrast with this, and an additional argument in favor 
of contagion, is the fact that if these children, born of leprous parents, 
and without a blemish, be left with their parents and associate with 
lepers they contract the disease. 

A home for boys born of leprous parents is now under considera- 
tion, and a small appropriation has been made by the government for 
that purpose. In connection with this subject, and in the absence of 
prohibitive measures relative to the cohabitation of lepers, those best 
informed here say that the fertility of lepers is not great, and that 
many of the progeny of such die in early childhood of diseases other 
than leprosy. 

Prevailing types of the disease. — The two principal types seen here 
are the tubercular and anaesthetic, and sometimes a mixed form. The 
tubercular form is the most abundant and exceeds the anaesthetic 
variety by three or four to one. It is characterized by the presence 
of tubercles on the face and other parts of the body, infiltration of the 



LEPROSY IN THE UNITED STATES. 109 

cheeks, nose, forehead, and lobes of the ears. The eyebrows are lost 
and the countenance assumes a leonine expression. There is thicken- 
ing of the fingers and toes, swelling of the hands, feet, and limbs, and 
leprous patches on the chest, abdomen, back, and nates. It hardly 
ever attacks the scalp. In the anaesthetic variety the favorite points 
of attack are the facial, ulnar, and peroneal nerves. The nerve sheath 
is invaded by the bacilli, the trunk of the nerves is thickened and per- 
ceptibly enlarged. There may or may not be leprous patches on the 
body and possibly leprous ulcers in the mouth or nose, but these are 
more common and severe in the tubercular forms. Paralysis and 
wasting of muscles follow, and there are peculiar deformities of the 
hands and feet; palmar and planter ulcers often form. The anaesthetic 
type is slow in progress and msij last for many years. In the severe 
forms of leprosy the fingers, toes, and even the limbs are lost, the 
eyes are destroyed, all of the viscera and tissues of the body are gradu- 
ally invaded, and the leper dies a revolting mass of humanity. Skin 
diseases are very common among lepers here, and in the early stages 
interfere with the diagnosis. 

Medical treatment. — The Hawaiian government, with a liberality 
which is deserving of high praise, has made every effort to employ dif- 
ferent measures vaunted as cures for leprosy. Their own physicians 
have tried many remedies, and in 1883 Dr. Edward Arning, of Switz- 
erland, was induced to come to Hawaii and serve the government as a 
specialist to investigate the subject of leprosy, He accomplished much 
in the line of investigation, but little relative to curative treatment. 
He resigned in 1889, and was succeeded in the same }^ear by Dr. A. 
Lutz, of Sao Paulo, Brazil, a pupil of Dr. Unna, of Hamburg. 

Under the influence of good food, improved hygienic surroundings, 
and treatment of a tonic nature, the disease improves and sometimes is 
arrested in a manner similar to cases of tuberculosis, but the tendency 
to relapse is great and the cases of aborted leprosy are not numerous. 
Among the medicinal remedies most valued are sodium salicylate, salol, 
creosote, gurgun and chalamoogra oils, pyrogallic acid, chrysarobin, 
ichtyol, lysol, and mercurials in cases associated with syphilis. 

Dr. Alvarez has tried a bouillon prepared from a culture of the 
bacillus prodigiosus used as an injection once daily, beginning with 
12 c. c. and increasing gradually until 80 c. c. were used. 

This was tried in twelve leper boys brought from the settlement at 
Molokai, and the experiments extended over a period of three months. 
At the end of the period the boys were examined by the medical 
board and two of them declared free from leprosy and returned to 
their homes. Another showed marked improvement, but the condi- 
tion of the others was not changed. He also tried tiryruus and thy- 
roid glands extract and dry powder. The result was negative in the 
case of the thymus, but from the thyroid gland were satisfactory. 



110 LEPBOSY IN THE UNITED STATES. 

He has also tried the serum of Dr. Carrasquilla, of Bogota, Colombia. 
Temporary improvement in all and marked benefit in one case resulted, 
which continued for six weeks; "the tubercles which had covered his 
face, ears, and chest had, with very few exceptions, disappeared 
entirely." Baths of various kinds, including the Goto system, have 
also been tried. They are all beneficial, but not curative. 

Dr. F. R. Day, port physician, and member of the Hawaiian board 
of health, who visited Japan in 1897, informs me that the Kusatsu 
Springs in that country have a beneficial and curative effect in leprosy. 
These waters contain the sulphates of aluminum, iron, calcium, mag- 
nesium, soda, and potash, and have a large percentage of free hydro- 
chloric and sulphuric acids. 

An imitation of the waters of these springs was tried here, but with- 
out any positive results. The moxa has also been used to destroy the 
tubercles, and with good results. The curative treatment of leprosy 
has up to the present yielded meager results. Hawaii presents a suit- 
able field for the scientific study and investigation of leprosy. 

Present outlook. — The Hawaiian authorities have accomplished much 
in their efforts to prevent the spread of leprosy in the face of the dif- 
ficulties the} 7 have had to contend with, the principal of which has 
been the indifference and want of cooperation on the part of the native 
race, who are the most susceptible to the disease- 
In the past segregation has been abhorrent to them; the} 7 do not 
fear leprosy, and cases are concealed from the authorities as long as 
possible. It has been stated to me, by one in a position to know, that 
in spite of the efforts to segregate lepers many are still at large on 
the different islands. Segregation has now been practiced, in a man- 
ner, since 1866, a period of thirty -two years, and should have pro- 
duced more positive results in diminishing the number of cases. 

The number of cases at Molokai at the present time shows no great 
diminution when compared with former years, but in explanation of 
this the authorities state that the large number is due to stricter meth- 
ods of segregation observed since the fall of the monarch} 7 , and that 
the number of cases at large is few compared with former years. 

The humane and praiseworthy method of providing for the care of 
lepers at Molokai has made the place attractive to some of the natives, 
and it is said that many try to acquire the disease in order that they 
may live at Molokai, at the expense of the Government, for the rest 
of their days. 

Stricter segregation is demanded, and intercourse between those 
unaffected and the settlement should be prohibited or allowed under 
more rigid methods of procedure, which would prohibit actual min- 
gling with those diseased. Cohabitation with or between lepers should 
be prohibited. House to house inspection at proper intervals has 
never been practiced, and the buildings and effects of lepers have not 



LEPROSY IN THE UNITED STATES. Ill 

been disinfected or destroyed. Importation of races from endemic 
areas of leprosy should be conducted only under the most rigid S}^stem 
of inspection, restricted, or prohibited, and cremation of the bodies of 
the dead from leprosy should be practiced. 

Precautions necessary to prevent the introduction of leprosy into the 
United States from the Hawaiian Islands. — The period of incuba- 
tion in leprosy is so long and variable (from three to seven or ten 
years), its detection in the early stages so difficult, and the fact that 
leprous patches may first appear on the unexposed parts of the body, 
such as the upper parts of the arms, chest, back, and nates, and that 
leprous ulcers may be present in the upper part of the nasal passages, 
makes its detection b} T ordinary quarantine methods uncertain. 

In pronounced cases detection is easy, but those rarely emigrate,, 
and the greatest difficulty would be met with in the slight cases occur- 
ring in the white or mixed races. 

The native Hawaiian rarely emigrates, and those who leave their 
homes generally go as sailors, although 1 have been informed that 
there is a small colony of Hawaiians in Salt Lake City, Utah, who 
were induced to go there by the Mormon missionaries. Inquiry as to 
the presence or absence of leprosy among them would be interesting. 

It is possible for persons with leprosy undeveloped, and for the 
slighter cases, to pass from one countiy to another without detection, 
and the fact of its presence in various parts of the United States is- 
evidence that quarantine restrictions do not exclude it. 

Few medical men are familiar with the appearance of leprosy in its 
early stages, and cases are often diagnosed as other skin diseases, and 
the fact that skin diseases such as psoriasis, various forms of taenia, 
chloasma, scabies, eiythema, etc., are often associated with leprosy 
makes its detection still more difficult. 

Restrictive measures should be adopted to control the departure of 
all emigrants from endemic foci of leprosy at the point of departure,, 
and these should consist of a careful inquiry into the family and sani- 
tary history of each emigrant, a rigid physical examination and disin- 
fection of his effects. Similar procedures at the port of arrival should 
be adopted and a record of the destination of the emigrant preserved. 

Adoption of the above-named measures would restrict the importa- 
tion of the disease so far as it is possible to do so, but such proceedings 
could be still further aided by the Government of the United States 
assuming control of measures for the suppression of leprosy in the 
possessions recently acquired by annexation and by conquest, viz, the 
Hawaiian and Philippine Islands and the island of Cuba, in all of 
which leprosy exists to a greater or less extent. 

In so doing it would assume its share among the nations in stamp- 
ing out this pest of ages, and would set an example which might, with 
undoubted benefit to the welfare of mankind, be emulated by the 
enlightened nations of the world. 



112 LEPROSY IN THE UNITED STATES. 

I am indebted to the Hon. W. O. Smith, attorney-general of Hawaii, 
president of the board of health, the medical members, and the execu- 
tive officer, Mr, C. B. Reynolds, for many favors. 



[Report from United States public health reports, October 11, 1901.] 
DESCRIPTION OF THE LEPER SETTLEMENT ON THE ISLAND OF MOLOKAI. 

Honolulu, H. I. , September 20, 1901. 

Sir: I have the honor to make the following report of my visit to 
the leper settlement on the island of Molokai: 

This visit was made on the invitation of the Hawaiian Territorial 
board of health, the authority for leaving my station for this purpose 
having been granted by Bureau letter of June 1*2, 1901. 

The board of health makes regularly an annual trip to the settle- 
ment, and as every detail for an easy and thorough inspection is 
arranged beforehand, one is able to see and learn more in a day in fol- 
lowing them in their investigations than would be possible in a week 
under ordinaiy circumstances. 

We left Honolulu at 9 p. m. of September 6, and arrived at Kalau- 
papa about 7 o'clock the following morning. The leper settlement is 
located upon, or may be said in a general way to comprise a tongue- 
shaped peninsula, which juts out into the ocean from about the center 
of the northern coast of Molokai. This tongue of land is shut off from 
the rest of the island by a mountain range which extends east and west 
along the northern coast, and which presents to the sea and also to the 
leper settlement a series of bold, precipitous, and rugged cliffs which 
rise to elevations varying from 1,800 to 3,000 feet. The steamer 
approaches the peninsula at a right angle, thereby giving the observer 
an excellent idea of the relation which it bears to the rest of the 
island. Indeed, the sight in the early morning is a very impressive 
one. As the sun rises the peninsula is thrown into a shadow and the 
lofty cliffs are brought into bold relief. The huge furrows on the 
face of the precipice soon come into view, causing one for the moment 
the vagary that it, too, has assumed a leonine countenance after its 
man}^ years of vigil over the unfortunates below and against the escape 
of whom it has ever formed a most discouraging barrier. As the 
steamer draws nearer, the pretty little town of Kalaupapa comes into 
view. At a distance it looks like any prosperous little town, but when 
the anchor is dropped one is near enough to see the white cottages and 
churches, which are surrounded in most instances by stone or lava 
fences inclosing yards planted with tropical fruits and flowers. I was 
reminded of a summer resort I had seen somewhere. The shore is 
lined with large rocks, and, on account of the almost constant north- 
erly swell, is rather dangerous to approach, even in a small boat, 




No. 1. MACULAR LEPROSY. 




No. 2. AN/ESTHETIC LEPROSY— LOSS OF FINGERS AND TOES. 




No. 3. TUBERCULO-AN/ESTHETIC LEPROSY, SHOWING THE 'LEONINE"' COUNTENANCE. 



LEPROSY IN THE UNITED STATES. 113 

which, by the wa} T , is the only means of making a landing. There 
were at least 400 lepers, the greater part of them gaily dressed and 
decorated with flowers ("leis"), gathered at the landing to meet us. 
The leper band was playing, and things in general took on the 
appearance of a country fair. 

The crowd had gathered both in anticipation of the visit of the board 
of health and to greet their friends and relatives who had made the 
trip with us. I was immediately struck by the fact that while I saw 
a number of distorted faces, indeed some even in a frightful condition, 
I did not see an unhappy one. 1 saw several lepers with their faces 
furrowed and distorted beyond recognition wearing white duck trou- 
sers and straw hats of the most modern shape, these latter adorned, 
as is almost inevitable in Hawaii, with u leis." Notwithstanding the 
incongruity of this combination of Hawaiian holiday dress and leprosy, 
one could not but admire the hopeful and cheerful way in which these 
poor people resigned themselves to their fate. Be it said to the credit 
of some one that such contentment can only thrive on a comfortable 
mode of life and good treatment. 

The peninsula has an area of 8 square miles, being only a very small 
part of the island of Molokai, with its area of 261 square miles. I 
mention this because a great man}^ have the impression that the whole 
of Molokai is given up to the segregation of lepers. The breadth of 
the base of the peninsula where it joins the cliffs is 2f miles; breadth 
at the center, 2i; and length, 1 mile. 

The soil is composed of disintegrated lava and sand, and with irri- 
gation is very productive. The village of Kalaupapa is situated on 
the western shore not far removed from the face of the cliff, and on 
the eastern shore, similarly situated, is the town of Kalawao. Between 
these towns, but nearer to Kalaupapa than to Kalawao, is the extinct 
crater of Kahukoo. This rises to an elevation of 493 feet above the 
sea level, and is supposed to have formed during its period of activity 
the land on which the leper settlement now stands. 

The village of Kalawao is exposed to the full force of the usually 
prevailing northeast trade winds, and on this account presents a rather 
bleak appearance. It is said that during the winter months the climate 
here is most unpleasant, being bleak, cold, and rain}'. 

Kalaupapa, on the other hand, is protected by the crator of Kahukoo, 
and being further removed from the mountains, has the benefit of the 
sun's rays. The tropical vegetation and the abundance of grass here 
show the good climatic advantages which this place possesses. 

About 600 lepers live in Kalaupapa, and probably one-third of this 
number in Kalawao. They- have, however, taken up their houses here 
and there throughout the peninsula, giving to the latter in general the 
appearance of an eastern suburban town. 

S. Doc. 269 8 



114 LEPROSY IN THE UNITED STATES. 

A great many of the lepers have saddle horses, and some of them 
very good ones. The board of health hired enough of them to mount 
the whole party, and we were soon on our tour of inspection. Our 
first trip was to Waikolu Valley, where the board of health taro patches 
are located. On account of the scarcity of taro throughout the islands 
the board of health has undertaken its cultivation for the lepers since 
1897. This is done under the supervision of Mr. Reynolds, the superin- 
tendent of the settlement, and the labor is performed by the lepers, 
who are paid for this at current rates. 

From this valley comes the water supply for the whole settlement. 
From springs in the mountain side an 8-inch pipe carries at the present 
time 1,500,000 gallons of water daily. It is said that the development 
of ten times this quantity would be possible. The psa'ty next visited 
the town of Kalawao. I do not believe I ever took a horseback ride 
affording such a variety of scenery in such a short space of time. The 
trip across from Kalaupapa to Kalawao was not unlike a trip across 
the rolling country of Virginia, but suddenly, with little warning, we 
were in a narrow bridle bath with the waves dashing at the horses' 
feet on one side and on the other our elbows touching the absolutely 
perpendicular precipice rising nearly 3,000 feet. 

Grand as the sight was, it is said that after a rain storm, when the 
sides of the cliff have numerous cascades shooting from them into the 
space below, the effect is much finer. The scenery suddenly changes 
when the Waikolu Valley is entered. This gorge, which is shut in on 
three sides b} r towering ramparts of rock, with its floor of green taro, 
terraced upward and backward almost as far as the eye can reach, is 
one of the finest sights I have ever seen. 

The town of Kalawao was next inspected. Here is located the church 
built by Father Damien, who, in the year 1873, gave his life to the 
lepers. The grave of this great good man is also here. The appearance 
of the town in general was very good. The houses were not so good as 
those in Kalaupapa, and perhaps showed their age more, yet they did 
not show neglect, and the extreme neatness of their yards and the 
roads in front of them was remarkable, calling forth from the inspect- 
ing party many words of praise for the superintendent of the settle- 
ment, Mr. Reynolds. The Baldwin Home, for leper boys, was next 
visited. This is run under the supervision of Brother Dutton, and 
has at this writing 112 inmates. Here among these boys we saw lep- 
rosy in all of its forms and in almost every stage, from the slight 
fullness between the eyes to the marked types of furrowed or leonine 
faces, with ear lobes elongated and ulcerating surfaces, and from the 
slightest anaesthetic forms, affecting perhaps only the ulnar nerve, to 
the most revolting mutilations. The leper boys have organized a 
band, and they pla} r ed a number of selections for us. They were 



LEPROSY IN THE UNITED STATES. 115 

dressed in very neat uniforms, and played, I thought, marvelously 
well. 

There were several well-advanced cases of tubercular leprosy among 
them, and it was plain that this band would soon lose at least two of 
its members on account of the mutilation which their disease causes. 
This fact made their entertainment a rather pathetic one. We visited 
the bathrooms used in connection with the Goto treatment, which, by 
the way, I was informed was the only treatment regularly carried out 
at the settlement. The patients are bathed two or three times daily 
in warm water, of a temperature from 90° to 100° F. An infusion of 
a few ounces of hichiyoo bark, together with a certain proportion of 
taifunshi and sulphur, is placed in each bath. In connection with the 
bath certain remedial agents are used internally. These are given in 
the form of a tea and also of a pill. Their nature is unknown. 1 was 
told that b} T promoting cleanliness and free perspiration the Goto 
baths were beneficial. 

The party now returned to Kalaupapa and visited the Bishop Home 
for leper girls. This is managed b\ T the Catholic sisters, and has at 
this writing 109 inmates. The institution presented a particularly 
neat and well-kept appearance. The wards were nicely kept and the 
patients seemed very comfortable. I did not notice very many 
advanced cases of leprosy, except in the hospital, where there were 
several presenting the most marked deformities, and apparently in an 
almost moribund state. In one case the nose had been completely 
absorbed. I noticed here one leper mother with a nonleprous child. 
I was informed that there were 78 such children in the settlement. 
The board of health transfers to the Kapiolani Home, in Honolulu, 
the nonleprous children of lepers, provided the consent of the parents 
is given. 

The board of health has just inaugurated a new system for prevent- 
ing the lepers and their relatives and friends from embracing and 
kissing each other during this annual visit. It consists in marching 
the visitors immediately from the steamer landing to a corral with a 
double fence. The friends are compelled to remain inside this inclo- 
sure, and the lepers are allowed to gather around and talk to them 
through the bars. As there is little use in sending lepers to Molokai 
if their friends are to be allowed to visit and establish with them the 
intercourse referred to above, this measure must appeal even to the 
lay mind as being one absolutely necessary for the protection of the 
community at large. While before visitors were allowed to go to 
Molokai only once a year, under the corral system they are allowed to 
visit their unfortunate friends and relatives at any time. 

A new home, the Sea View House, has been recently built at 
Kalaupapa for the helpless lepers. This is a very substantial, not to 



116 LEPKOSY IN THE UNITED STATES. 

say somewhat imposing, structure. There are 26 inmates here, who 
are cared for and fed by the steward in charge and his assistants. 

At noon the party repaired to the superintendent's home, where the 
board of health had provided luncheon. The house is large and 
spacious and is surrounded by well-kept grounds. No lepers are ever 
allowed within this inclosure. Over 300 lepers had assembled in front 
of the gate of this place by the time luncheon was over, and the visit- 
ing party were given a concert by the Kalaupapa band and Kalaupapa 
quintette. After this was over the president of the board of health 
announced that he was ready to listen to any complaints or petitions 
which the assembled crowd had to lay before him. The grievances 
proved to be remarkably few in number and either trivial or unreason- 
able in nature. The board of health store was then visited. This is 
kept by a leper, an employee of the board, and is not unlike the aver- 
age country store of the better class. The receipts in 1900 amounted 
to $12,411.45. As the necessities of life, including clothes, are fur- 
nished free to every leper, the output of this amount of money yearly 
seems remarkable, and shows that even if hope is being deferred the 
leper is in some ways as susceptible to the foibles and vanities of life 
as are any of us. 

There were 909 lepers and 164 clean persons at the settlement at the 
time of our visit. Of the clean persons, 67 were kokuas or helpers — 
i. e., persons who feed and take care of helpless lepers — 19 were in the 
administrative department, including the superintendent, his assistant, 
the Catholic brothers and sisters, and servants, and 78 were nonleprous 
children of lepers. 1 inquired particularly into the chances of the 
infection of these clean people with lepros}^ while in the discharge of 
their various duties. The general opinion was that in time they would 
become lepers. 

It was not possible to obtain any statistics on this point as these clean 
people are coming and going all of the time. I was informed, how- 
ever, that in the last ten years only ten clean residents have become 
lepers, and that at the present time there were no lepers at the settle- 
ment belonging to this class. The precautions of certain members of 
the visiting party prior to landing, together with the absolute lack of 
precaution on the part of others, attracted my attention. Not believ- 
ing it to be wise to spend the day handling persons surely, and things 
almost surely, infected with leprosy, and knowing that from the 
amount of horseback riding that would be done the chances of new 
abrasions on the hands would be increased, I drew on a pair of gloves, 
and I noticed about one-third of the party doing the same thing. 

I noticed that several men whom I knew would be exposed, especi- 
ally during the day, did not wear gloves. On asking them why they 
went with bare hands, they stated that the risk for them was small, 



LEPEOSY I]ST THE UNITED STATES. 117 

but that we with gloves were apt to forget and rub our noses or eyes 
without removing our gloves, while they were being reminded con- 
tinually of their infected bare hands. I mention this to show that 
while the relatively small number of cases of leprosy among the white 
population in the Hawaiian Islands must prove in a measure that to 
this class of persons the disease is only mildly contagious, the fear 
that some members of our party had of even touching their noses or 
eyes with infected gloves demonstrated how little is actually known 
of the contagiousness of this disease from a practical point of view; 
this, too, on the part of persons who have been handling leprosy for 
the past fifteen or twenty years. 

The results of known exposure to leprosy are interesting, and show 
an uncertainty as to the chances of individual infection which to my 
mind make this disease one of the most difficult to operate against. 
For instance, I saw a leper at the settlement, a white man, whose face 
was already markedly infiltrated, who claims to have received his 
infection from a hoe which he took for a moment from the hands of a 
native who was cleaning up his yard, which man he saw at once was a 
leper. He was a carpenter by trade, and always had a certain number 
of abrasions on his hands. He developed leprosy shortly after this 
occurrence. On the other hand, there is said to be a man on the 
island of Maui who lived fifteen years with his leper wife and had 11 
children by her, neither he nor the children ever developing leprosy. 
Women are said to be less liable to the disease, there being man} r cases 
of women having two or three husbands, and these latter, although 
previously clean, falling victims to leprosy, the women remaining 
clean until after the menopause, when the disease, supposed by some 
to have been in the meanwhile dormant, showed itself. 

As an example of the length of time which a person may spend in 
intimate contact with leprosy without acquiring it, the history of the 
leper martyr, Father Damien, is very interesting: 

Father Damien, a Belgian of good physique, age 31 years, arrived 
at the settlement in 1873. He was perfectly well until 1881, when pains 
in the left foot were complained of. Believing it to be only rheuma- 
tism he consulted Dr. Arning, who diagnosed it at once as leprosy. It 
was six months afterwards before the disease became manifest. In the 
latter part of 1885 a tubercle appeared on the lobe of the ear, and sub- 
sequently the infiltration of the forehead and cheeks began, together 
with the loss of the eyebrows. Thus the clinical picture was complete. 
I was informed by Mr. Reynolds, the superintendent, that the disease 
shows a much slower advance in those persons who perform manual 
labor or else take regular exercise. In this it shows a slight analogy 
to tuberculosis. The varieties of leprosy, tubercular and anaesthetic, 
are said to exist at the settlement in about equal number. 



118 LEPROSY LIS" THE UNITED STATES. 

It is said that cases of tubercular and anaesthetic leprosy rarely occur 
in the same family. The three oldest patients now at the settlement 
arrived in the years 1874, 1875, and 1879, respectively. 

I saw the one who arrived in 1875, and was surprised at the rela- 
tively slow advancement of the disease in his case. 

The number of commitments to the settlement each year has grad- 
ually decreased during the past ten years. The following shows these 
transactions for the time stated: 

Commitments: 1891, 132; 1892, 101; 1893, 211; 1891, 138; 1895, 
106; 1896, 143; 1897, 122; 1898, 81; 1899, 61; 1900, 85. 

It has been contended by some that even the number sent up during 
the past three years, while relatively smaller than the number for 
the preceding years, was larger than it should be, if one was to 
believe that leprosy was decreasing, a result promised when theMolo- 
kai settlement was first established. The facts show that the hunt 
throughout the islands for lepers has never before been carried on 
with as much vigor as it is now, and that the decrease in the annual 
number of commitments is the greatest proof of the fact that the dis- 
ease is decreasing. 

I noticed a great many lepers wearing glasses, and I saw several 
totally blind. I was told that the eyes were affected in nearly 10 per 
cent of the cases. In some cases the blindness was caused by a simple 
invasion of the optic nerve. In others the process had spread into 
the anterior chamber from the conjunctiva. 

I noticed a peculiar hoarseness that several of the very sick lepers 
had, but the disgusting smell that I had heard so much about I found 
no worse than that found in almost any almshouse, however well kept 
it might be. It is said that those patients having leprous ulcerations 
in the nose give off a most horrible smell, unless they receive very 
active local treatment with antiseptics. 

The leprous ulceration found in the bowels is believed to be caused 
by swallowing the pus secreted from these nasal sores. Dr. Pratt, 
the executive officer of the board of health, told me of a case which 
had lately arrived at the settlement in which skin taken from several 
localities showing the leprous process had failed to show the bacilli, 
while the latter were demonstrated at once in the nasal secretion. 

A great many observers believe that infection from leprosy takes 
place most frequently through the inhalation of dust. The fact that 
in the past ten years only 10 clean persons have been infected at 
Molokai, notwithstanding the amount of dust that is constantly pres- 
ent all over the settlement, does not add weight to the inhalation the- 
ory, even though we assume that these 10 infections were caused in 
this way alone. 



LEPROSY IN THE UNITED STATES. 119 

The cost of maintaining the settlement is much less than would be 
naturally expected. The general expenses are itemized as follows: 

Board and cartage for lepers $1, 500 

Medical examinations 1, 000 

Freight and passage 18, 000 

Kalihi Station expenses 12, 000 

Baldwin Home expenses 6, 000 

Bishop Home expenses 2, 000 

Lumber and building materials 6, 000 

Incidentals 3, 000 

Medicines , 10, 000 

Beef and cattle 46, 000 

Poi 26,000 

Bread 8,000 

Rice 8, 000 

Flour and other supplies 12, 500 

Total 160, 000 

In other words, nearly 1,100 persons are housed, fed, clothed, and 
governed for 1160,000 for two years, or for $80,000 a year. 

That this is a relatively small amount on which to operate such a 
settlement an} T one will admit. That an additional 1,000 lepers could 
be placed there and kept at a far smaller relativexost was a fact that 
was also apparent. 

The number of lepers the place is capable of accommodating is prac- 
tically without limit, and it occurred to me more than once that a site 
so suitable and isolated should be made more use of — that is, made our 
national leper sanitarium. 

At 5 p. m. the inspection was over and we returned to the vessel. 
The band played us off, and the same crowd was assembled at the 
landing, some of them giving the native wail to their departing friends. 
We were soon on board the steamer and on our way home. 1 have to 
thank President H. C. Sloggett and other members of the board of 
health, including Dr. Pratt, the executive officer, for very many 
courtesies and much information while on this trip. 

I arrived in Honolulu about 11 p. m. of September 7, and was on 
duty as usual the next morning. 
Respectfully, 

L. E. Gofer, 
Passed Assistant Surgeon, XI. S. M. H. S.. 
Chief Quarantine Officer, Hawaiian Islands. 

The Surgeon-General Marine-Hospital Service. 



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Library of Congress 
Branch Bindery, 1903 



